Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 01073892A | IN |
NPI | 1033462239 |
---|---|
Provider Name | Dr. Jason Ronald Kovac |
First Address | Greenwood, IN 46143-1049 |
Second Address | Indianapolis, IN 46260-1950 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2012 |
Last Update Date | 16/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000876722 | ANTHEM (01) | IN |
201227510 | (05) | IN |