Provider Demographics
NPI:1649373861
Name:NOVAK, DANIEL M (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:M
Last Name:NOVAK
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 1:3108 S. FILLMORE ST.
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79110-1026
Mailing Address - Country:US
Mailing Address - Phone:806-374-8400
Mailing Address - Fax:806-373-9446
Practice Address - Street 1:3108 S. FILLMORE ST.
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79110-1026
Practice Address - Country:US
Practice Address - Phone:806-374-8400
Practice Address - Fax:806-373-9446
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7007207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122789405Medicaid
TXP00150436OtherRAILROAD MEDICARE
TX8R5335OtherBCBS
TX122789405Medicaid
C19955Medicare UPIN
TXP00150436Medicare ID - Type UnspecifiedRAILROAD MEDICARE