Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | ME108790 | FL |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 205711 | LA |
NPI | 1023227683 |
---|---|
Provider Name | Paul M Novakovich |
First Address | Ruston, LA 71270-5941 |
Second Address | Ruston, LA 71270-5941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 12/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003720500 | (05) | FL |
129805 | (05) | AL |
129809 | (05) | AL |
14E9E | BLUE CROSS BLUE SHIELD (01) | FL |
593-07447 | BLUE CROSS BLUE SHIELD (01) | AL |
593-07448 | BLUE CROSS BLUE SHIELD (01) | AL |