Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 29419 | AZ |
NPI | 1003881442 |
---|---|
Provider Name | Dr. Eric N Novack |
First Address | Phoenix, AZ 85038-9870 |
Second Address | Glendale, AZ 85304-1273 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 16/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3Z3939 | HEALTHNET (01) | AZ |
789232 | (05) | AZ |