=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275615684
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRUCE M DOW MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2006
-----------------------------------------------------
Last Update Date | 11/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1019 IYANNOUGH RD STE 9
-----------------------------------------------------
City | HYANNIS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02601-1839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-862-8061
-----------------------------------------------------
Fax | 508-862-8064
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1019 IYANNOUGH RD STE 9
-----------------------------------------------------
City | HYANNIS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02601-1839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-862-8061
-----------------------------------------------------
Fax | 508-862-8064
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | G68375
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 238483
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------