Provider Demographics
NPI:1033260641
Name:NOWAK, PAUL C (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:C
Last Name:NOWAK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1225 E CLIFF DR
Mailing Address - Street 2:BLDG. 3 SUITE 100
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4732
Mailing Address - Country:US
Mailing Address - Phone:915-545-2600
Mailing Address - Fax:915-533-8950
Practice Address - Street 1:1225 E CLIFF DR
Practice Address - Street 2:BLDG. 3 SUITE 100
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4732
Practice Address - Country:US
Practice Address - Phone:915-545-2600
Practice Address - Fax:915-533-8950
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK53662080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092302101Medicaid
TX412159840OtherTAX ID