Healthcare Provider Details

I. General information

NPI: 1871516500
Provider Name (Legal Business Name): BRIAN SCOTT MCDOWELL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12455 E 100TH ST N SUITE 280
OWASSO OK
74055-4600
US

IV. Provider business mailing address

8812 N 127TH EAST AVE
OWASSO OK
74055-5016
US

V. Phone/Fax

Practice location:
  • Phone: 918-274-9700
  • Fax:
Mailing address:
  • Phone: 918-274-6766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4212
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: