Provider Demographics
NPI:1407824121
Name:ROWELL, RAYMOND J (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:J
Last Name:ROWELL
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 1:42 FENTON ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4144
Mailing Address - Country:US
Mailing Address - Phone:925-443-3232
Mailing Address - Fax:925-443-3239
Practice Address - Street 1:42 FENTON ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4144
Practice Address - Country:US
Practice Address - Phone:925-443-3232
Practice Address - Fax:925-443-3239
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81772207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG12672Medicare UPIN
CAZZZ17888ZMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER