Provider Demographics
NPI:1275538233
Name:STOVAK, MARK L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:STOVAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:401 W. SECOND ST.
Mailing Address - Street 2:#235D
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503
Mailing Address - Country:US
Mailing Address - Phone:775-682-8175
Mailing Address - Fax:775-327-2006
Practice Address - Street 1:123 17TH ST.
Practice Address - Street 2:MS 316
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89557
Practice Address - Country:US
Practice Address - Phone:775-784-1533
Practice Address - Fax:775-784-8075
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0426465207QS0010X
NV15867207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100271000CMedicaid
NVV112175Medicare UPIN
KS058160Medicare PIN
KS100271000CMedicaid