Provider Demographics
NPI:1386939130
Name:KOVALSKI, SAMUEL (PA-C)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:KOVALSKI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9101 LYNDON B JOHNSON FWY
Mailing Address - Street 2:SUITE 710
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-2057
Mailing Address - Country:US
Mailing Address - Phone:972-792-5700
Mailing Address - Fax:972-788-4707
Practice Address - Street 1:4461 COIT RD
Practice Address - Street 2:SUITE 405
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0521
Practice Address - Country:US
Practice Address - Phone:972-377-9200
Practice Address - Fax:972-377-9300
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA04823363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical