Basic Information
| Provider Information | |||||||||
| NPI: | 1598976763 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOVAL | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26726 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787550726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124078686 | ||||||||
| FaxNumber: | 5124066216 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 W 38TH ST STE 205 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123241864 | ||||||||
| FaxNumber: | 5124199016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2007 | ||||||||
| LastUpdateDate: | 05/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 05/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2343 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | N9083 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 284059704 | 05 | TX | MEDICAID | 284059702 | 05 | TX | MEDICAID | 284059703 | 05 | TX | MEDICAID | 284059701 | 05 | TX | MEDICAID |