Provider Demographics
NPI:1760427280
Name:DOWELL, CHARLES W (PA-C, ATC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:DOWELL
Suffix:
Gender:M
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-2417
Mailing Address - Fax:970-652-2927
Practice Address - Street 1:1035 GARDEN OF THE GODS RD STE 120
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3416
Practice Address - Country:US
Practice Address - Phone:719-365-3200
Practice Address - Fax:719-365-7680
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-002254363A00000X
COPA.0006093363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q38561Medicare UPIN
Q38561Medicare UPIN
WA8855060Medicare ID - Type Unspecified