Healthcare Provider Details

I. General information

NPI: 1750491130
Provider Name (Legal Business Name): GEORGE H. DOWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11477 OLDE CABIN RD STE 210
SAINT LOUIS MO
63141-7129
US

IV. Provider business mailing address

11477 OLDE CABIN RD SUITE 200
SAINT LOUIS MO
63141-7130
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number32184
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: