Provider Demographics
NPI:1700898608
Name:KOVNAT, PAUL JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JAY
Last Name:KOVNAT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1650 HOSPITAL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4769
Mailing Address - Country:US
Mailing Address - Phone:505-982-4276
Mailing Address - Fax:505-983-7571
Practice Address - Street 1:1650 HOSPITAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4769
Practice Address - Country:US
Practice Address - Phone:505-982-4276
Practice Address - Fax:505-983-7571
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2008-05-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM74-50207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM15396Medicaid
NM2123477Medicare PIN
NMC97900Medicare UPIN