MEDICARE: DR. CHRISTY VOWELL D.O.

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	207Q00000X	Family Medicine Physician	T-2021	MS
2	207Q00000X	Family Medicine Physician	20499	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	T-2021	OTHER	MS	TEMPORARY LICENSE
2	20499	OTHER	MS	MS STATE BOARD OF MEDICAL LICENSURE

General Provider Information

NPI Number	:	1942481437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTY VOWELL D.O.

Provider Business Mailing Address
First Line	:	1301 VETERANS MEMORIAL BLVD
Second Line	:
City	:	EUPORA
State	:	MS
Zip	:	39744-2064
Country	:	US
Telephone Number	:	662-258-7200
Fax Number	:	662-258-5871

Provider Business Practice Location Address
First Line	:	1301 VETERANS MEMORIAL BLVD
Second Line	:
City	:	EUPORA
State	:	MS
Zip	:	39744-2064
Country	:	US
Telephone Number	:	662-258-7200
Fax Number	:	662-258-5871

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

Provider Enumeration Date	:	11/26/2007
Last Update Date	:	03/31/2011

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