Provider Demographics
NPI:1417947409
Name:MCGOWAN, THOMAS MANNION (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MANNION
Last Name:MCGOWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 FROSTWOOD DR
Mailing Address - Street 2:STE 261
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2420
Mailing Address - Country:US
Mailing Address - Phone:713-974-6643
Mailing Address - Fax:832-358-1602
Practice Address - Street 1:902 FROSTWOOD DR
Practice Address - Street 2:STE 261
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2420
Practice Address - Country:US
Practice Address - Phone:713-974-6643
Practice Address - Fax:832-358-1602
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7841207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034862501Medicaid
TX034862501Medicaid
TX00MF46Medicare ID - Type Unspecified