Provider Demographics
NPI:1730280017
Name:MCGOWAN, KATHLEEN
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E IDAHO ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6223
Mailing Address - Country:US
Mailing Address - Phone:208-345-5250
Mailing Address - Fax:208-345-2364
Practice Address - Street 1:100 E IDAHO ST
Practice Address - Street 2:SUITE 400
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6223
Practice Address - Country:US
Practice Address - Phone:208-345-5250
Practice Address - Fax:208-345-2364
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM4790207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003838300Medicaid
ID1116711Medicare PIN
IDC47881Medicare UPIN