Healthcare Provider Details

I. General information

NPI: 1508834110
Provider Name (Legal Business Name): CHRISTOPHER PHILIP NOVAK M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 LETRADO ST STE D
SANTA FE NM
87505-4146
US

IV. Provider business mailing address

605 LETRADO ST STE D
SANTA FE NM
87505-4146
US

V. Phone/Fax

Practice location:
  • Phone: 505-476-2670
  • Fax: 505-476-2694
Mailing address:
  • Phone: 505-476-2670
  • Fax: 505-476-2694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD2009-0030
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: