Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QS0010X | Family Doctor - Sports Medicine | 0426465 | KS |
Y | 207QS0010X | Family Doctor - Sports Medicine | 15867 | NV |
NPI | 1275538233 |
---|---|
Provider Name | Dr. Mark L Stovak |
First Address | Reno, NV 89503 |
Second Address | Reno, NV 89557 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 20/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100271000C | (05) | KS |
G33022 | (02) | KS |
V112175 | (02) | NV |