Provider Demographics
NPI:1326085325
Name:COWAN, IAN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:DAVID
Last Name:COWAN
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 1:505 S 336TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6328
Mailing Address - Country:US
Mailing Address - Phone:253-838-6180
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:11315 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3004
Practice Address - Country:US
Practice Address - Phone:253-588-1711
Practice Address - Fax:253-838-6418
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026373207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2164COOtherBSWA
WACO3544OtherBSWA
WA0218527OtherLIWA
WA8114563Medicaid
WA4675COOtherBSWA CASCADE
WA0171296OtherLIWA
WAG8864424Medicare PIN
WA8114563Medicaid
WA0171296OtherLIWA
WAG8907496Medicare PIN
WAP00226308Medicare PIN