Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | R3971 | KY |
Y | 207Q00000X | Family Doctor | 51005 | KY |
NPI | 1003212630 |
---|---|
Provider Name | Dr. Brandon Cowan |
First Address | Mount Vernon, KY 40456-2725 |
Second Address | Mount Vernon, KY 40456 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2014 |
Last Update Date | 17/11/2021 |