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Individual
MR. JAMES JOSEPH PAVAO
Active
Individual
MR. JAMES JOSEPH PAVAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1325
SC
363AS0400X
Surgical Physician Assistant
1582
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0733PA
—
SC
01
—
5551
MEDICARE GROUP #
SC
01
—
GP5004
MEDICAID GROUP #
SC
01
—
GP5005
MEDICAID GROUP #
SC
01
—
GP5006
MEDICAID GROUP #
SC
01
—
GP5007
MEDICAID GROUP #
SC
01
—
GP5072
MEDICAID GROUP #
SC
01
—
P00648630
RAILROAD MEDICARE ID
SC
Enumeration date
10/12/2006
Last updated
10/20/2015
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