Provider Demographics
NPI:1528257573
Name:PODNEWICH, JOHN K (NP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:PODNEWICH
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 1:1908 HIGHWAY 365
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-5503
Mailing Address - Country:US
Mailing Address - Phone:409-729-1900
Mailing Address - Fax:409-729-1905
Practice Address - Street 1:1908 HIGHWAY 365
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-5503
Practice Address - Country:US
Practice Address - Phone:409-729-1900
Practice Address - Fax:409-729-1905
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX660665207P00000X
TXAP116185363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGOtherPENDING