Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | ME41051 | FL |
Y | 208600000X | Surgeon | ME41051 | FL |
NPI | 1003973645 |
---|---|
Provider Name | Dr. Russell Warren Novak |
First Address | Orlando, FL 32886-3407 |
Second Address | Sarasota, FL 34239-3506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 14/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D56999 | (02) | FL |