Basic Information
| Provider Information | |||||||||
| NPI: | 1922378330 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAGAANAN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 650426 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752650426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722331999 | ||||||||
| FaxNumber: | 9722333666 | ||||||||
| Practice Location | |||||||||
| Address1: | 13601 PRESTON RD | ||||||||
| Address2: | STE 1000W | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752404911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9726638523 | ||||||||
| FaxNumber: | 9726638329 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2012 | ||||||||
| LastUpdateDate: | 11/08/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 088835 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 8901UC | 01 | TX | BCBS | OTHER | P01069384 | 01 | TX | RAILROAD | OTHER | 290277702 | 05 | TX | MEDICAID | 290277703 | 05 | TX | MEDICAID |