MEDICARE: DR. JAMES MOWERY 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	207R00000X	Internal Medicine Physician	036047503	IL

General Provider Information

NPI Number	:	1225086143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES MOWERY M.D.

Provider Business Mailing Address
First Line	:	13707 W JACKSON ST
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-3188
Country	:	US
Telephone Number	:	815-337-1887
Fax Number	:	815-338-6297

Provider Business Practice Location Address
First Line	:	4309 W MEDICAL CENTER DR
Second Line	:	SUITE B202
City	:	MCHENRY
State	:	IL
Zip	:	60050-8419
Country	:	US
Telephone Number	:	815-344-3900
Fax Number	:	815-344-8957

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	04/24/2009

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