Healthcare Provider Details

I. General information

NPI: 1114967445
Provider Name (Legal Business Name): ROBERT JOHN MOWRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6967 WILSON DR
DEXTER MI
48130-9257
US

IV. Provider business mailing address

6967 WILSON DR
DEXTER MI
48130-9257
US

V. Phone/Fax

Practice location:
  • Phone: 517-250-1502
  • Fax:
Mailing address:
  • Phone: 517-250-1502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberRM071538
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: