MEDICARE: BENNETT Y COWAN 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	207RH0003X	Hematology & Oncology Physician	MD0000009364	TN

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	:	1649263500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENNETT Y COWAN JR. MD

Provider Business Mailing Address
First Line	:	271 MEDICAL PARK BLVD
Second Line	:
City	:	BRISTOL
State	:	TN
Zip	:	37620-7455
Country	:	US
Telephone Number	:	423-968-2311
Fax Number	:	423-968-2312

Provider Business Practice Location Address
First Line	:	271 MEDICAL PARK BLVD
Second Line	:
City	:	BRISTOL
State	:	TN
Zip	:	37620-7455
Country	:	US
Telephone Number	:	423-968-2311
Fax Number	:	423-968-2312

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	03/07/2008

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