MEDICARE: JEFFREY L MCGOWEN 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	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	L8833	TX

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
2	8P6302	OTHER	TX	BLUE CROSS/BLUE SHIELD
3	L8833	OTHER	TX	STATE LICENSE

General Provider Information

NPI Number	:	1548262710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY L MCGOWEN M.D.

Provider Business Mailing Address
First Line	:	6301 HARRIS PKWY STE 300
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4249
Country	:	US
Telephone Number	:	817-877-3432
Fax Number	:	817-346-4394

Provider Business Practice Location Address
First Line	:	6301 HARRIS PKWY STE 300
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4249
Country	:	US
Telephone Number	:	817-877-3432
Fax Number	:	817-346-4394

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	03/20/2015

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