Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 34006965 | OH |
N | 207QA0401X | Family Doctor - Addiction Medicine | 34.003340 | OH |
NPI | 1023002011 |
---|---|
Provider Name | Dr. Larry Ira Cowan |
First Address | Zanesville, OH 43702-1821 |
Second Address | Thornville, OH 43076-8010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2005 |
Last Update Date | 31/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0492024 | (05) | OH |
D89542 | (02) |