Provider Demographics
NPI:1932334877
Name:NOVAK, RAYMOND WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:WILLIAM
Last Name:NOVAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 N SWAN RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1213
Mailing Address - Country:US
Mailing Address - Phone:520-419-2499
Mailing Address - Fax:
Practice Address - Street 1:10500 E TANQUE VERDE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-8931
Practice Address - Country:US
Practice Address - Phone:520-749-5980
Practice Address - Fax:520-749-4852
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14286323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility