Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | K5366 | TX |
NPI | 1033260641 |
---|---|
Provider Name | Dr. Paul C Nowak |
First Address | El Paso, TX 79902-4732 |
Second Address | El Paso, TX 79902-4732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
092302101 | (05) | TX |
412159840 | TAX ID (01) | TX |