=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578567392
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARL DAVID MCCOWEN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2005
-----------------------------------------------------
Last Update Date | 12/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1628 S MILDRED ST STE 104
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98465-1628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-565-6777
-----------------------------------------------------
Fax | 253-565-8777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1628 S MILDRED ST STE 104
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98465-1628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-565-6777
-----------------------------------------------------
Fax | 253-565-8777
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | MD00017146
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------