Basic Information
| Provider Information | |||||||||
| NPI: | 1326571449 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAVNICA | ||||||||
| FirstName: | JOZEF | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3730 PLAZA WAY FL 5 | ||||||||
| Address2: | |||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993382718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092216550 | ||||||||
| FaxNumber: | 5062216511 | ||||||||
| Practice Location | |||||||||
| Address1: | 3730 PLAZA WAY FL 5 | ||||||||
| Address2: | |||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993382718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092216550 | ||||||||
| FaxNumber: | 5092216511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2017 | ||||||||
| LastUpdateDate: | 06/30/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208600000X | 37455 | AL | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.