Provider Demographics
NPI:1710204540
Name:BRIAN A. MCDOWELL PODIATRY CORPORATION
Entity Type:Organization
Organization Name:BRIAN A. MCDOWELL PODIATRY CORPORATION
Other - Org Name:PREMIER PODIATRY AND ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:RIPP
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:916-961-3434
Mailing Address - Street 1:6620 COYLE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6333
Mailing Address - Country:US
Mailing Address - Phone:916-786-7023
Mailing Address - Fax:
Practice Address - Street 1:6620 COYLE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6333
Practice Address - Country:US
Practice Address - Phone:916-786-7023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116074207XX0005X
CAE1358213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty