Provider Demographics
NPI:1033228283
Name:MOWER, DOUGLAS R (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:R
Last Name:MOWER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 N 1100 E
Mailing Address - Street 2:SUITE A
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2054
Mailing Address - Country:US
Mailing Address - Phone:801-855-3841
Mailing Address - Fax:801-855-3834
Practice Address - Street 1:226 N 1100 E
Practice Address - Street 2:SUITE A
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2054
Practice Address - Country:US
Practice Address - Phone:801-855-3841
Practice Address - Fax:801-855-3847
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT1787061205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT09287Medicaid
UT000004215Medicare PIN
UT09287Medicaid