Provider Demographics
NPI:1003955113
Name:KOVACS, GABOR (MD)
Entity Type:Individual
Prefix:
First Name:GABOR
Middle Name:
Last Name:KOVACS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2334 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-1979
Mailing Address - Country:US
Mailing Address - Phone:904-572-3074
Mailing Address - Fax:904-775-5906
Practice Address - Street 1:2334 S 8TH ST
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-1979
Practice Address - Country:US
Practice Address - Phone:904-572-3074
Practice Address - Fax:904-775-5906
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME13348208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD18419Medicare UPIN
NJ528145Medicare ID - Type Unspecified