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General NPI Number Information
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NPI Number | 1740648211
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Entity Type | Organization
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Legal Business Name | STEPHEN R KOVACS DO PLLC
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Dates
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Enumeration Date | 01/29/2016
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Last Update Date | 01/29/2016
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Provider Practice Location Address
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Address Line | 8426 N 123RD EAST AVE
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City | OWASSO
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State | OK
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Zip | 74055-2130
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Country | US
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Telephone | 918-376-4980
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Fax | 918-376-4981
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Provider Business Mailing Address
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Address Line | 8426 N 123RD EAST AVE
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City | OWASSO
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State | OK
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Zip | 74055-2130
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Country | US
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Telephone | 918-376-4980
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Fax | 918-376-4981
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN ROBERT KOVACS
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Credential | DO
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Telephone | 918-376-4980
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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 | 3860
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License Number State | OK
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