MEDICARE: BENJAMIN D COWLEY JR. MD

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	207RN0300X	Nephrology Physician	22666	OK

General Provider Information

NPI Number	:	1427027457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN D COWLEY JR. MD

Provider Business Mailing Address
First Line	:	NEPHROLOGY / AAT5300
Second Line	:	OUHSC / 800 STANTON L YOUNG BLVD
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104
Country	:	US
Telephone Number	:	405-271-6842
Fax Number	:	405-271-6496

Provider Business Practice Location Address
First Line	:	1000 NE 13TH ST STE 1G
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5040
Country	:	US
Telephone Number	:	405-271-8478
Fax Number	:	405-271-4230

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	08/14/2024

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