Healthcare Provider Details

I. General information

NPI: 1124058672
Provider Name (Legal Business Name): SHIRL CURTIS COWLEY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 SOUTH MAIN SUITE 3
ST GEORGE UT
84770
US

IV. Provider business mailing address

754 SOUTH MAIN SUITE 3
ST GEORGE UT
84770
US

V. Phone/Fax

Practice location:
  • Phone: 435-628-2671
  • Fax: 435-634-1601
Mailing address:
  • Phone: 435-628-2671
  • Fax: 435-634-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1032980501
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number103298-0501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: