Provider Demographics
NPI:1902815079
Name:JENIFER R KOWALIK, MD, PA
Entity Type:Organization
Organization Name:JENIFER R KOWALIK, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOWALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-637-1955
Mailing Address - Street 1:1150 N LOOP 1604 W STE 108-636
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-4500
Mailing Address - Country:US
Mailing Address - Phone:806-637-1955
Mailing Address - Fax:806-637-2169
Practice Address - Street 1:703 E FELT ST
Practice Address - Street 2:
Practice Address - City:BROWNFIELD
Practice Address - State:TX
Practice Address - Zip Code:79316-3439
Practice Address - Country:US
Practice Address - Phone:806-637-1955
Practice Address - Fax:806-637-2169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-06
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty