Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 36029 | KY |
N | 208000000X | Pediatrician | 36029 | KY |
NPI | 1669450094 |
---|---|
Provider Name | Gordon C Gowans |
First Address | Louisville, KY 40202 |
Second Address | Louisville, KY 40202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 04/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64021017 | (05) | KY |
H29878 | (02) |