Provider Demographics
NPI:1578567392
Name:MCCOWEN, KARL DAVID (MD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:DAVID
Last Name:MCCOWEN
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 1:1628 S MILDRED ST
Mailing Address - Street 2:STE 104
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-1628
Mailing Address - Country:US
Mailing Address - Phone:253-565-6777
Mailing Address - Fax:253-565-8777
Practice Address - Street 1:1628 S MILDRED ST
Practice Address - Street 2:STE 104
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465-1628
Practice Address - Country:US
Practice Address - Phone:253-565-6777
Practice Address - Fax:253-565-8777
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017146207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0255612OtherSTATE L&I
WAG8912824OtherMEDICARE
WA0300739OtherL&I
WAP00784717OtherRAILROAD MEDICARE
WAGAB03012Medicare PIN
WAG8912824OtherMEDICARE
WAG8885589Medicare PIN