Provider Demographics
NPI:1083607683
Name:COVINGTON, KARL KAVANAUGH (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:KAVANAUGH
Last Name:COVINGTON
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:PO BOX 38759
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77238-8759
Mailing Address - Country:US
Mailing Address - Phone:713-695-8686
Mailing Address - Fax:713-695-6661
Practice Address - Street 1:411 W PARKER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091-3202
Practice Address - Country:US
Practice Address - Phone:713-695-8686
Practice Address - Fax:713-695-6661
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2012-10-04
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
TXG9083208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080336301Medicaid
TX83150KMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
TX080336301Medicaid