Provider Demographics
NPI:1093785792
Name:NOWELL, ROBERT T (DO)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:T
Last Name:NOWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-0607
Mailing Address - Country:US
Mailing Address - Phone:419-468-0511
Mailing Address - Fax:419-468-8579
Practice Address - Street 1:955 BUCYRUS RD
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833
Practice Address - Country:US
Practice Address - Phone:419-468-4220
Practice Address - Fax:419-462-7019
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007226N207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000367567Medicaid
OH2209514Medicaid
OH000000367567Medicaid
H18868Medicare UPIN