Healthcare Provider Details

I. General information

NPI: 1245275510
Provider Name (Legal Business Name): MATTHEW T SOWLE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 N MAPLE AVE
NEW HAMPTON IA
50659-1142
US

IV. Provider business mailing address

308 N MAPLE AVE
NEW HAMPTON IA
50659-1142
US

V. Phone/Fax

Practice location:
  • Phone: 641-394-2151
  • Fax: 641-394-1999
Mailing address:
  • Phone: 641-394-2151
  • Fax: 641-394-1999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1107
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: