Healthcare Provider Details

I. General information

NPI: 1376000307
Provider Name (Legal Business Name): GEORGE H DOWELL, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11477 OLDE CABIN RD STE 210
CREVE COEUR MO
63141-7129
US

IV. Provider business mailing address

PO BOX 66726
SAINT LOUIS MO
63166-6726
US

V. Phone/Fax

Practice location:
  • Phone: 314-997-5208
  • Fax: 314-997-5368
Mailing address:
  • Phone: 314-593-2694
  • Fax: 314-997-5368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY L ELLIOTT
Title or Position: BILLING MANAGER
Credential:
Phone: 314-593-2694