Healthcare Provider Details

I. General information

NPI: 1811429756
Provider Name (Legal Business Name): STUART THOMAS COWLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S LIMESTONE STE A102
LEXINGTON KY
40508-3008
US

IV. Provider business mailing address

4645 VILLAGE SQUARE DR STE C
PADUCAH KY
42001-7448
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-7246
  • Fax: 859-257-6768
Mailing address:
  • Phone: 270-228-0118
  • Fax: 270-228-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR4374
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number55460
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number55460
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number55460
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: