Healthcare Provider Details

I. General information

NPI: 1821160342
Provider Name (Legal Business Name): STEVEN COWGILL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WEST ARBOR DR MAIL CODE 0039
SAN DIEGO CA
92103-0039
US

IV. Provider business mailing address

9500 GILLMAN DRIVE # 0039
LA JOLLA CA
92093-0039
US

V. Phone/Fax

Practice location:
  • Phone: 858-822-0455
  • Fax: 619-543-3183
Mailing address:
  • Phone: 858-822-0455
  • Fax: 619-543-3183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG55231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: