Provider Demographics
NPI:1679658256
Name:R. GORDON MOWRY, M.D.
Entity Type:Organization
Organization Name:R. GORDON MOWRY, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:R
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:MOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-343-8030
Mailing Address - Street 1:100 MEMORIAL HOSPITAL DR STE 2B
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1129
Mailing Address - Country:US
Mailing Address - Phone:251-343-8030
Mailing Address - Fax:251-343-2499
Practice Address - Street 1:100 MEMORIAL HOSPITAL DR STE 2B
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1129
Practice Address - Country:US
Practice Address - Phone:251-343-8030
Practice Address - Fax:251-343-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty