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General NPI Number Information
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NPI Number | 1093753709
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Entity Type | Individual
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Provider Name | CORY M KOVAC PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 02/02/2015
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Provider Practice Location Address
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Address Line | 19350 E SILVER CREEK LN
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-9064
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Country | US
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Telephone | 480-718-5400
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Fax | 877-666-4624
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Provider Business Mailing Address
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Address Line | 729 S BURK ST
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City | GILBERT
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State | AZ
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Zip | 85296-2815
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Country | US
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Telephone | 480-588-6213
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 3363
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3363
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License Number State | AZ
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