Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 48556 | AZ |
N | 207K00000X | Allergist & Immunologist | ME110800 | FL |
N | 208000000X | Pediatrician | 48556 | AZ |
N | 208000000X | Pediatrician | ME110800 | FL |
NPI | 1164756904 |
---|---|
Provider Name | Dr. Gregory Michael Cowan |
First Address | Peoria, AZ 85381-4820 |
Second Address | Peoria, AZ 85381-4820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2009 |
Last Update Date | 26/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003990800 | (05) | FL |
935585 | (05) | AZ |