Provider Demographics
NPI:1518973239
Name:COWAN, MARYALICE LINDSEY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARYALICE
Middle Name:LINDSEY
Last Name:COWAN
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 1:7400 FANNIN ST STE 750
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1948
Mailing Address - Country:US
Mailing Address - Phone:713-795-5053
Mailing Address - Fax:713-795-5389
Practice Address - Street 1:7400 FANNIN ST STE 750
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1948
Practice Address - Country:US
Practice Address - Phone:713-795-5053
Practice Address - Fax:713-795-5389
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3866207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113977604Medicaid
TXP00AD74Medicaid
TXP00AD74Medicaid
TX8F23194Medicare PIN
TX113977604Medicaid
TXC14820Medicare UPIN