Healthcare Provider Details

I. General information

NPI: 1629050349
Provider Name (Legal Business Name): THOMAS MOWERY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 J ST
SACRAMENTO CA
95816-4403
US

IV. Provider business mailing address

3160 J ST
SACRAMENTO CA
95816-4403
US

V. Phone/Fax

Practice location:
  • Phone: 916-473-9426
  • Fax: 916-669-8549
Mailing address:
  • Phone: 916-473-9426
  • Fax: 916-669-8549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG30638
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: