Provider Demographics
NPI:1598982530
Name:COWGILL, TODD E (PAC)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:E
Last Name:COWGILL
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 21ST STREET
Mailing Address - Street 2:INDIAN RIVER WALK-IN CLINIC
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960
Mailing Address - Country:US
Mailing Address - Phone:772-299-1092
Mailing Address - Fax:772-978-1960
Practice Address - Street 1:652 21ST STREET
Practice Address - Street 2:INDIAN RIVER WALK-IN CLINIC
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960
Practice Address - Country:US
Practice Address - Phone:772-299-1092
Practice Address - Fax:772-978-1962
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2126363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant