Healthcare Provider Details

I. General information

NPI: 1629368733
Provider Name (Legal Business Name): DAVID C MCCOWAN LSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2011
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22202 MEANDERING SPRINGS DR
SPRING TX
77389-1463
US

IV. Provider business mailing address

PO BOX 2550
ROWLETT TX
75030-0938
US

V. Phone/Fax

Practice location:
  • Phone: 214-227-2457
  • Fax: 214-764-0880
Mailing address:
  • Phone: 214-227-2457
  • Fax: 214-764-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number3553
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberSA00614
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: