Provider Demographics
NPI:1659481471
Name:KOVACH, JAN P (MD, CPI)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:P
Last Name:KOVACH
Suffix:
Gender:F
Credentials:MD, CPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 ENCINO PL NE
Mailing Address - Street 2:SUITE 24
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2611
Mailing Address - Country:US
Mailing Address - Phone:505-224-7400
Mailing Address - Fax:505-224-7404
Practice Address - Street 1:717 ENCINO PL NE
Practice Address - Street 2:SUITE 24
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2611
Practice Address - Country:US
Practice Address - Phone:505-224-7400
Practice Address - Fax:505-224-7404
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM92272207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine