Provider Demographics
NPI:1902250624
Name:JOHN, PAUL T (NP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:T
Last Name:JOHN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 ECHO HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-1571
Mailing Address - Country:US
Mailing Address - Phone:281-785-4697
Mailing Address - Fax:
Practice Address - Street 1:2406 ECHO HARBOR DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-1571
Practice Address - Country:US
Practice Address - Phone:281-785-4697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130734363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care