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NPI Code Detail

MEDICARE: HILLARY SHANE MOWBRAY M.D.

MEDICARE: HILLARY SHANE MOWBRAY 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
1208000000XPediatrics PhysicianM7452TX

General Provider Information

NPI Number : 1699961466
Entity Type Code : Individual
Provider Name (Legal Business Name) : HILLARY SHANE MOWBRAY M.D.
Provider Business Mailing Address
First Line : PO BOX 359
Second Line :
City : EVANSVILLE
State : IN
Zip : 47703-0359
Country : US
Telephone Number : 812-485-1220
Fax Number :
Provider Business Practice Location Address
First Line : 3700 WASHINGTON AVE
Second Line :
City : EVANSVILLE
State : IN
Zip : 47714-0542
Country : US
Telephone Number : 812-485-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2007
Last Update Date : 03/14/2013

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