Provider Demographics
NPI:1689672446
Name:DOWD, GREGORY CLINTON (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:CLINTON
Last Name:DOWD
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 1:3704 NORTH BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3606
Mailing Address - Country:US
Mailing Address - Phone:318-443-4576
Mailing Address - Fax:318-449-5579
Practice Address - Street 1:3704 NORTH BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3606
Practice Address - Country:US
Practice Address - Phone:318-443-4576
Practice Address - Fax:318-449-5579
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022440174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1679933Medicaid
LA5W799B059Medicare ID - Type Unspecified
LA0867910001Medicare NSC
LA1679933Medicaid
LACT1911Medicare PIN