Provider Demographics
NPI:1619934429
Name:COWELL, PAMELA D (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:D
Last Name:COWELL
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 1:120 14TH AVE SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3718
Mailing Address - Country:US
Mailing Address - Phone:253-435-5200
Mailing Address - Fax:253-435-8873
Practice Address - Street 1:120 14TH AVE SE
Practice Address - Street 2:SUITE C
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3718
Practice Address - Country:US
Practice Address - Phone:253-435-5200
Practice Address - Fax:253-435-8873
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00036597207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1108026Medicaid
WAGAB11134Medicare UPIN