Provider Demographics
NPI:1386689958
Name:MCGOWEN ST. CHILDREN'S CLINIC & PREVENTIVE MEDICINE INSTITUTE
Entity Type:Organization
Organization Name:MCGOWEN ST. CHILDREN'S CLINIC & PREVENTIVE MEDICINE INSTITUTE
Other - Org Name:PROFESSIONAL ORGANIZATION
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/OWNER/PRES.OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BROBBEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD,MPH
Authorized Official - Phone:713-655-1006
Mailing Address - Street 1:PO BOX 667638
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77266-7638
Mailing Address - Country:US
Mailing Address - Phone:713-655-1006
Mailing Address - Fax:713-571-9630
Practice Address - Street 1:2900 SMITH ST
Practice Address - Street 2:STE 101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-3446
Practice Address - Country:US
Practice Address - Phone:713-655-1006
Practice Address - Fax:713-571-9630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0899208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
31381OtherAMERICAN BD OF PEDIATRICS
236-282-0OtherECFMG NUMBER
MA48268OtherMASS BD OF REGISTRATION
TXG0899OtherST. BD OF MED EXAMINERS
TXS0045716OtherSTATE DPS NUMBER
TXS0045716OtherSTATE DPS NUMBER
TXS0045716OtherSTATE DPS NUMBER