Provider Demographics
NPI:1952575391
Name:NOVAK, MELISSA A (DO)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:NOVAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 SW VERMONT ST
Mailing Address - Street 2:GABRIEL PARK FAMILY HEALTH CENTER
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-1020
Mailing Address - Country:US
Mailing Address - Phone:501-494-9992
Mailing Address - Fax:
Practice Address - Street 1:4411 SW VERMONT ST
Practice Address - Street 2:GABRIEL PARK FAMILY HEALTH CENTER
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-1020
Practice Address - Country:US
Practice Address - Phone:501-494-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO155928207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine