1538150354 NPI number — DR. JOHN DAVID COWSAR JR. D.O.

Table of content: DR. JOHN DAVID COWSAR JR. D.O. (NPI 1538150354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538150354 NPI number — DR. JOHN DAVID COWSAR JR. D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COWSAR
Provider First Name:
JOHN
Provider Middle Name:
DAVID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538150354
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21130 FOREST WATERS CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDEN RIDGE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78266-2777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-295-4908
Provider Business Mailing Address Fax Number:
210-295-4215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
FAMILY MEDICINE CLINIC MCWETHY
Provider Second Line Business Practice Location Address:
2991 GARDEN AVENUE. BLDG 1279
Provider Business Practice Location Address City Name:
FT. SAM HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78234-6250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-295-4908
Provider Business Practice Location Address Fax Number:
210-295-4215
Provider Enumeration Date:
11/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  F3867 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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