Provider Demographics
NPI:1972589471
Name:KOVAR, JAY LANCE (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:LANCE
Last Name:KOVAR
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:PO BOX 200993
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-0993
Mailing Address - Country:US
Mailing Address - Phone:281-784-1111
Mailing Address - Fax:281-784-1555
Practice Address - Street 1:504 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2808
Practice Address - Country:US
Practice Address - Phone:409-539-1111
Practice Address - Fax:409-788-8044
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1602207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137648513Medicaid
TX8AP262OtherBCBS
TX8R8313OtherBCBS
TX137648511Medicaid
TX137648512Medicaid
TX137648514Medicaid
TX8F9637OtherBCBSTX PROV NO
TX8J9129Medicare PIN
TX8F9637OtherBCBSTX PROV NO
TX8AP262OtherBCBS
TX137648514Medicaid
TXP00690974Medicare Oscar/Certification
TX137648512Medicaid
TX137648513Medicaid