Provider Demographics
NPI:1689612145
Name:NOWAK, VICKI G (MD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:G
Last Name:NOWAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4559
Mailing Address - Country:US
Mailing Address - Phone:850-784-7722
Mailing Address - Fax:850-784-6903
Practice Address - Street 1:1303 MOSLEY DR
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-5625
Practice Address - Country:US
Practice Address - Phone:850-784-7722
Practice Address - Fax:850-784-6903
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92945207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272550900Medicaid
03528OtherBLUE CROSS
FL257724100Medicaid
03528OtherBLUE CROSS
FL272550900Medicaid
FLK0538Medicare PIN