Healthcare Provider Details

I. General information

NPI: 1700898608
Provider Name (Legal Business Name): PAUL JAY KOVNAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 HOSPITAL DR SUITE 200
SANTA FE NM
87505-4769
US

IV. Provider business mailing address

1650 HOSPITAL DR SUITE 200
SANTA FE NM
87505-4769
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-4276
  • Fax: 505-983-7571
Mailing address:
  • Phone: 505-982-4276
  • Fax: 505-983-7571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number74-50
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: