Healthcare Provider Details

I. General information

NPI: 1083636484
Provider Name (Legal Business Name): PHILLIP C ROWDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 08/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 NORTH PINE STREET
OLLA LA
71465-4804
US

IV. Provider business mailing address

210 LINTON AVE
NATCHEZ MS
39120-2316
US

V. Phone/Fax

Practice location:
  • Phone: 318-495-3131
  • Fax:
Mailing address:
  • Phone: 601-431-4015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number06648R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: