Provider Demographics
NPI:1124025887
Name:NOWICKI, STEPHEN PAUL (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PAUL
Last Name:NOWICKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8637 FREDERICKSBURG RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1283
Mailing Address - Country:US
Mailing Address - Phone:210-617-4708
Mailing Address - Fax:210-617-4075
Practice Address - Street 1:1028 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-1630
Practice Address - Country:US
Practice Address - Phone:830-816-2312
Practice Address - Fax:830-816-2349
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ8699207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G19832Medicare UPIN