Provider Demographics
NPI:1073515185
Name:MCDOWELL, BRIAN A (DPM)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:A
Last Name:MCDOWELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 COYLE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6333
Mailing Address - Country:US
Mailing Address - Phone:916-961-3434
Mailing Address - Fax:916-961-0540
Practice Address - Street 1:6620 COYLE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6333
Practice Address - Country:US
Practice Address - Phone:916-961-3434
Practice Address - Fax:916-961-0540
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1358213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA124611Medicare PIN
CA6489140001OtherDME SUPPLIER NUMBER
CAT10913Medicare UPIN
CA00E13580Medicare ID - Type Unspecified
E1358OtherCA LICENSE