Provider Demographics
NPI:1407910318
Name:GOWIN, DONNA J (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:J
Last Name:GOWIN
Suffix:
Gender:F
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:RT. 1 BOX 4 - 1
Mailing Address - Street 2:
Mailing Address - City:KOSHKONONG
Mailing Address - State:MO
Mailing Address - Zip Code:65692
Mailing Address - Country:US
Mailing Address - Phone:417-280-5556
Mailing Address - Fax:
Practice Address - Street 1:202 RISNER AVE.
Practice Address - Street 2:
Practice Address - City:THAYER
Practice Address - State:MO
Practice Address - Zip Code:65791
Practice Address - Country:US
Practice Address - Phone:417-280-5556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050383552084P0800X, 2084P0804X
TXJ12532084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000828GMedicaid
TXF34689Medicare UPIN
TX00828GMedicare ID - Type UnspecifiedINDIVIDUAL