Provider Demographics
NPI:1821412768
Name:MCGOWN, PAUL RAYMOND (PA-C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:RAYMOND
Last Name:MCGOWN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:RAYMOND
Other - Last Name:MCGOWN
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:PA166047
Mailing Address - Street 1:PO BOX 6149
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-0149
Mailing Address - Country:US
Mailing Address - Phone:503-352-8657
Mailing Address - Fax:503-434-8597
Practice Address - Street 1:2935 SW CEDAR HILLS BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1342
Practice Address - Country:US
Practice Address - Phone:503-352-6000
Practice Address - Fax:503-352-6080
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA166047363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant