Healthcare Provider Details

I. General information

NPI: 1629046545
Provider Name (Legal Business Name): JOHN D COWAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 E LAMAR ALEXANDER PKWY
MARYVILLE TN
37804-5015
US

IV. Provider business mailing address

PO BOX 5629
MARYVILLE TN
37802-5629
US

V. Phone/Fax

Practice location:
  • Phone: 865-977-4641
  • Fax: 865-977-4787
Mailing address:
  • Phone: 865-980-4844
  • Fax: 865-977-4787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD0000009032
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number9032
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: