Healthcare Provider Details

I. General information

NPI: 1902957715
Provider Name (Legal Business Name): CHRISTOPHER COWAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 10/02/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLANCHFIELD ARMY COMMUNITY HOSPITAL 650 JOEL DR
FORT CAMPBELL KY
42223
US

IV. Provider business mailing address

650 JOEL DR
FORT CAMPBELL KY
42223-5318
US

V. Phone/Fax

Practice location:
  • Phone: 270-956-0259
  • Fax: 270-798-8721
Mailing address:
  • Phone: 270-956-0259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101243583
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101243583
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: