Provider Demographics
NPI:1093753709
Name:KOVAC, CORY M (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CORY
Middle Name:M
Last Name:KOVAC
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 S BURK ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-2815
Mailing Address - Country:US
Mailing Address - Phone:480-588-6213
Mailing Address - Fax:
Practice Address - Street 1:19350 E SILVER CREEK LN
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-9064
Practice Address - Country:US
Practice Address - Phone:480-718-5400
Practice Address - Fax:877-666-4624
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3363207P00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ023682Medicaid
AZZ170283Medicare PIN
AZZ172913Medicare PIN