Provider Demographics
NPI:1205036555
Name:K JEAN JOVIAK MD PA
Entity Type:Organization
Organization Name:K JEAN JOVIAK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:JOVIAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-239-4659
Mailing Address - Street 1:PO BOX 770584
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34477-0584
Mailing Address - Country:US
Mailing Address - Phone:352-239-4659
Mailing Address - Fax:352-237-4055
Practice Address - Street 1:860 S VILLAGE DR N
Practice Address - Street 2:105
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-3024
Practice Address - Country:US
Practice Address - Phone:352-239-4659
Practice Address - Fax:352-237-4055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1792714OtherCIGNA
FL0105204OtherUNITED
FL080108978OtherRAILROAD MEDICARE
FL62326OtherBLUE CROSS BLUE SHIELD
FL961280OtherAETNA
FL045854600Medicaid
FL045854600Medicaid
FL62326OtherBLUE CROSS BLUE SHIELD
FLAD571Medicare PIN