Healthcare Provider Details

I. General information

NPI: 1861575417
Provider Name (Legal Business Name): TIMOTHY MICHAEL MCDOWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S 7TH AVE PHOENIX MEMORIAL HOSPITAL
PHOENIX AZ
85007
US

IV. Provider business mailing address

PO BOX 40850
MESA AZ
85274
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-5111
  • Fax:
Mailing address:
  • Phone: 480-839-3313
  • Fax: 480-839-4182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number31063
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: