Healthcare Provider Details

I. General information

NPI: 1164414595
Provider Name (Legal Business Name): WILLIAM WESTEL ROWE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 6TH ST
LEWISTON ID
83501-2434
US

IV. Provider business mailing address

3242 APACHE LN
PROVO UT
84604-4362
US

V. Phone/Fax

Practice location:
  • Phone: 208-750-7507
  • Fax:
Mailing address:
  • Phone: 406-781-7850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberDR.0068184
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0068184
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number10308904-1205
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number10895
License Number StateMT
# 5
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberDR.0068184
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMC-0214
License Number StateID
# 7
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number10308904-1205
License Number StateUT
# 8
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMC-0214
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: