Healthcare Provider Details

I. General information

NPI: 1760404065
Provider Name (Legal Business Name): GEORGE W MOWRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 S FAIRMONT AVE
LODI CA
95240-5118
US

IV. Provider business mailing address

1409 W VINE ST
LODI CA
95242-3861
US

V. Phone/Fax

Practice location:
  • Phone: 209-339-7575
  • Fax:
Mailing address:
  • Phone: 707-688-9896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG24980
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG24980
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: