Healthcare Provider Details

I. General information

NPI: 1043771942
Provider Name (Legal Business Name): THOMAS MICHAEL MCCOWN JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26004 104TH AVE SE
KENT WA
98030-7677
US

IV. Provider business mailing address

1902 A ST SE APT C308
AUBURN WA
98002-6683
US

V. Phone/Fax

Practice location:
  • Phone: 800-422-2844
  • Fax: 877-514-9952
Mailing address:
  • Phone: 206-696-5666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP61316851
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: