Healthcare Provider Details

I. General information

NPI: 1871728493
Provider Name (Legal Business Name): RICHARD LEE STOWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 N NORTHWOOD CENTER CT STE 101
COEUR D ALENE ID
83814
US

IV. Provider business mailing address

1233 N NORTHWOOD CENTER CT STE 101
COEUR D ALENE ID
83814-6190
US

V. Phone/Fax

Practice location:
  • Phone: 208-457-4211
  • Fax: 208-773-1473
Mailing address:
  • Phone: 208-457-4211
  • Fax: 208-773-1473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number10187A
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberM-14713
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberM-14713
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: