Provider Demographics
NPI:1700029832
Name:COWAN, IDEN M (MD)
Entity Type:Individual
Prefix:
First Name:IDEN
Middle Name:M
Last Name:COWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8015 SHOAL CREEK BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-8051
Mailing Address - Country:US
Mailing Address - Phone:512-467-7246
Mailing Address - Fax:512-467-7247
Practice Address - Street 1:8015 SHOAL CREEK BLVD STE 103
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-8051
Practice Address - Country:US
Practice Address - Phone:512-467-7246
Practice Address - Fax:512-467-7247
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE7901207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS2007OtherMEDICAL LICENSE