Provider Demographics
NPI:1710922497
Name:OW, CATHY L (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHY
Middle Name:L
Last Name:OW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4674 SNOW MESA DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8615
Mailing Address - Country:US
Mailing Address - Phone:970-482-3712
Mailing Address - Fax:970-266-4190
Practice Address - Street 1:4674 SNOW MESA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8615
Practice Address - Country:US
Practice Address - Phone:970-482-3712
Practice Address - Fax:970-266-4190
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34272207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY113449300Medicaid
CO01342724Medicaid
COE57925Medicare UPIN
COCOA105577Medicare PIN
COP00970414Medicare PIN
COA8918Medicare ID - Type Unspecified
COP00970414Medicare PIN