Provider Demographics
NPI:1437165719
Name:COWPER, PAMELA A (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:COWPER
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:PO BOX 13442
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78711-3442
Mailing Address - Country:US
Mailing Address - Phone:512-323-5465
Mailing Address - Fax:
Practice Address - Street 1:5656 BEE CAVES RD BLDG C
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5814
Practice Address - Country:US
Practice Address - Phone:512-323-5468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1176208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110202083Medicaid
TX046663303Medicaid
TX046663301Medicaid
TX046663304Medicaid
TX046663302Medicaid
TX88590JMedicare PIN
TX8K0621Medicare PIN
TXTXB154746Medicare PIN
TX046663303Medicaid