Provider Demographics
NPI:1669790663
Name:NOVICK, LAURENCE MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:MARTIN
Last Name:NOVICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:12033 AGENCY RD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-7718
Mailing Address - Country:US
Mailing Address - Phone:928-669-2137
Mailing Address - Fax:928-669-5860
Practice Address - Street 1:12033 AGENCY RD
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-7718
Practice Address - Country:US
Practice Address - Phone:928-669-2137
Practice Address - Fax:928-669-5860
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2010-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ7230207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZHSZ 136Medicare PIN