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General NPI Number Information
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NPI Number | 1851376586
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Entity Type | Individual
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Provider Name | MARK ALEXANDER NOVAS M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/15/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 149 HART ST
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City | SHEPPARD AFB
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State | TX
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Zip | 76311-3481
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Country | US
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Telephone | 904-386-8880
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9413
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City | WICHITA FALLS
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State | TX
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Zip | 76308-9413
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Country | US
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Telephone | 904-386-8880
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 80919
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License Number State | FL
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