Provider Demographics
NPI:1043252257
Name:MCGOWEN, BERNARD A (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:A
Last Name:MCGOWEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 FLORIDA DR
Mailing Address - Street 2:SUITE 121
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2380
Mailing Address - Country:US
Mailing Address - Phone:817-419-9155
Mailing Address - Fax:817-419-9412
Practice Address - Street 1:1217 FLORIDA DR
Practice Address - Street 2:SUITE 121
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2380
Practice Address - Country:US
Practice Address - Phone:817-419-9155
Practice Address - Fax:817-419-9412
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2716207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135471411Medicaid
TX135471409Medicaid
TX135471410Medicaid
TX8L2164Medicare PIN
TX8G3835Medicare PIN
TX135471409Medicaid
TX8L6313Medicare PIN