Provider Demographics
NPI:1740235423
Name:DOWDY, CARLA (PA)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:DOWDY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:EKALAKA
Mailing Address - State:MT
Mailing Address - Zip Code:59324-0046
Mailing Address - Country:US
Mailing Address - Phone:406-775-8738
Mailing Address - Fax:406-775-6479
Practice Address - Street 1:215 SANDY STREET
Practice Address - Street 2:
Practice Address - City:EKALAKA
Practice Address - State:MT
Practice Address - Zip Code:59324-0046
Practice Address - Country:US
Practice Address - Phone:406-775-8738
Practice Address - Fax:406-775-6479
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT43864363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ915994-01Medicaid
AZ915994-01Medicaid
AZQ37102Medicare UPIN