Provider Demographics
NPI:1962467696
Name:NOVICK, STEVEN LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:LOUIS
Last Name:NOVICK
Suffix:
Gender:M
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:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75461-0100
Mailing Address - Country:US
Mailing Address - Phone:903-783-1282
Mailing Address - Fax:903-783-1251
Practice Address - Street 1:3015 NE LOOP 286
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460
Practice Address - Country:US
Practice Address - Phone:903-783-1282
Practice Address - Fax:903-783-1251
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1346952085R0202X
TXK45142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00340876OtherMEDICARE RAILROAD
TX044087709Medicaid
TX044087715Medicaid
TX044087716Medicaid
ARE-11055OtherARKANSAS MEDICAL BOARD
FLME-134695OtherLICENSE
TX044087716Medicaid
TX044087709Medicaid
TXP01122203Medicare PIN
TX259686YLA1Medicare PIN