Individual
DR. JOHN PAVLOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2819 DENNY AVE, PASCAGOULA, MS 39581-5301
(228) 762-3466
(228) 762-6349
Mailing address
2101 HIGHWAY 90, GAUTIER, MS 39553-5340
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MS11764
MS
207Q00000X
Family Medicine Physician
Primary
11764
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00012527
—
MS
05
—
009928105
—
AL
01
—
080186277
MEDICARE RAILROAD
—
01
—
646000515
TRICARE
—
Enumeration date
01/12/2007
Last updated
12/22/2021
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