=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245275510
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW T SOWLE PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2006
-----------------------------------------------------
Last Update Date | 03/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 308 N MAPLE AVE
-----------------------------------------------------
City | NEW HAMPTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50659-1142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-394-2151
-----------------------------------------------------
Fax | 641-394-1999
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 308 N MAPLE AVE
-----------------------------------------------------
City | NEW HAMPTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50659-1142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-394-2151
-----------------------------------------------------
Fax | 641-394-1999
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 1107
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------