Provider Demographics
NPI:1164503033
Name:MCGOWEN, HENRY WILCOX II (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:WILCOX
Last Name:MCGOWEN
Suffix:II
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:PO BOX 2125
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76804-2125
Mailing Address - Country:US
Mailing Address - Phone:325-646-7899
Mailing Address - Fax:325-646-7768
Practice Address - Street 1:105 STRECKERT DR
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5956
Practice Address - Country:US
Practice Address - Phone:325-646-7899
Practice Address - Fax:325-646-7768
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6815174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D1365Medicare ID - Type Unspecified
TX8270N0Medicare PIN