Healthcare Provider Details

I. General information

NPI: 1740626183
Provider Name (Legal Business Name): MARK COWAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 E MCDOWELL RD FL 2
PHOENIX AZ
85006-2502
US

IV. Provider business mailing address

925 E MCDOWELL RD FL 2
PHOENIX AZ
85006-2502
US

V. Phone/Fax

Practice location:
  • Phone: 602-839-3339
  • Fax: 602-839-3300
Mailing address:
  • Phone: 602-839-3339
  • Fax: 602-839-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR73820
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: