Individual
DR. JAMES J. KONVICKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
K8644
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050087640
RR/MEDICARE
TX
05
—
1511685-01
—
TX
01
—
1511685-02
CSHCN
TX
01
—
8G1684
BLUE SHIELD
TX
Enumeration date
03/27/2006
Last updated
01/26/2022
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