Provider Demographics
NPI:1841218724
Name:GOW, IAN MACARTHUR (PA-N)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:MACARTHUR
Last Name:GOW
Suffix:
Gender:M
Credentials:PA-N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11386 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95946-9000
Mailing Address - Country:US
Mailing Address - Phone:889-662-3988
Mailing Address - Fax:844-460-4678
Practice Address - Street 1:11386 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:PENN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95946
Practice Address - Country:US
Practice Address - Phone:888-966-2398
Practice Address - Fax:844-460-4678
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11373363A00000X
CA354363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS55734Medicare UPIN
CA0PA113730Medicare PIN