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General NPI Number Information
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NPI Number | 1124025887
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Entity Type | Individual
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Provider Name | STEPHEN PAUL NOWICKI MD
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Gender | Male
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1028 N MAIN ST
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City | BOERNE
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State | TX
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Zip | 78006-1630
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Country | US
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Telephone | 830-816-2312
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Fax | 830-816-2349
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Provider Business Mailing Address
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Address Line | 8637 FREDERICKSBURG RD SUITE 105
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City | SAN ANTONIO
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State | TX
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Zip | 78240-1283
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Country | US
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Telephone | 210-617-4708
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Fax | 210-617-4075
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | J8699
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License Number State | TX
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