Healthcare Provider Details

I. General information

NPI: 1770533606
Provider Name (Legal Business Name): JOSE R NOVOA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 S 77TH ST WORKFIT
OMAHA NE
68114
US

IV. Provider business mailing address

140 S 77TH ST
OMAHA NE
68114
US

V. Phone/Fax

Practice location:
  • Phone: 402-934-4535
  • Fax: 402-934-5939
Mailing address:
  • Phone: 402-934-4535
  • Fax: 402-934-5939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number17836
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number17836
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: