MEDICARE: DR. HENRY F. SHOWAH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PE0005X	Undersea and Hyperbaric Medicine (Emergency Medicine) Physician	A52139	CA
2	207Q00000X	Family Medicine Physician	A52139	CA
3	207N00000X	Dermatology Physician	A52139	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043205784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY F. SHOWAH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 69
Second Line	:
City	:	BUFFALO VALLEY
State	:	TN
Zip	:	38548-0069
Country	:	US
Telephone Number	:	619-258-6200
Fax Number	:	619-258-0028

Provider Business Practice Location Address
First Line	:	6260 EL CAMINO REAL # 100
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-1609
Country	:	US
Telephone Number	:	760-476-2953
Fax Number	:	760-476-2963

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	12/03/2025

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