Individual
JACOB JOHN NOVAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2628 LONG PRAIRIE RD, SUITE 107, FLOWER MOUND, TX 75022-4839
(972) 899-6666
(972) 899-6665
Mailing address
PO BOX 961214, FORT WORTH, TX 76161-0214
(972) 899-6666
(972) 899-6665
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
K2766
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K2766
STATE LICENSE
TX
Enumeration date
03/21/2007
Last updated
07/08/2007
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