Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | H1147 | TX |
NPI | 1003847203 |
---|---|
Provider Name | Jack David Mcgowan |
First Address | Houston, TX 77046-0207 |
Second Address | Houston, TX 77030-2608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 07/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00J48W | BLUE CROSS (01) | TX |
130804101 | (05) | TX |
E70762 | (02) | TX |