Provider Demographics
NPI:1821194804
Name:COWAN, ROBERT J (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:COWAN
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:STE 150
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-2412
Mailing Address - Fax:970-490-4153
Practice Address - Street 1:13445 VOYAGER PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921
Practice Address - Country:US
Practice Address - Phone:719-219-0333
Practice Address - Fax:719-219-0320
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2019-05-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO00792363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC312428Medicare PIN
COR94698Medicare UPIN