Healthcare Provider Details

I. General information

NPI: 1639146178
Provider Name (Legal Business Name): MARK D MOWRY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 E 31ST ST
KEARNEY NE
68847-2926
US

IV. Provider business mailing address

PO BOX 1857
NORTH PLATTE NE
69103-1857
US

V. Phone/Fax

Practice location:
  • Phone: 308-647-6444
  • Fax:
Mailing address:
  • Phone: 308-647-6444
  • Fax: 866-902-2445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number156
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: