Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | MD21143 | TN |
NPI | 1063597979 |
---|---|
Provider Name | Dr. James Langston Cowan III |
First Address | West Memphis, AR 72301-2001 |
Second Address | West Memphis, AR 72301-2001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 26/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2896594 | (02) | TN |
3125751 | BC PROVIDER# (01) | TN |
3896594 | (05) | TN |
G47867 | (02) | TN |