Healthcare Provider Details

I. General information

NPI: 1275517625
Provider Name (Legal Business Name): ROBERT B MCCOWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7570 W 21ST ST N STE 1006B
WICHITA KS
67205
US

IV. Provider business mailing address

7570 W 21ST ST N STE 1006B
WICHITA KS
67205
US

V. Phone/Fax

Practice location:
  • Phone: 316-462-1208
  • Fax: 316-462-1214
Mailing address:
  • Phone: 316-462-1208
  • Fax: 316-462-1214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0421782
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: