Provider Demographics
NPI:1881629699
Name:MOWBRAY, DAVID NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NICHOLAS
Last Name:MOWBRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3271 N. CIVIC CENTER PLAZA
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251
Mailing Address - Country:US
Mailing Address - Phone:480-481-9223
Mailing Address - Fax:480-481-0248
Practice Address - Street 1:3271 N. CIVIC CENTER PLAZA
Practice Address - Street 2:SUITE 5
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251
Practice Address - Country:US
Practice Address - Phone:480-481-9223
Practice Address - Fax:480-481-0248
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2020-01-15
Deactivation Date:2019-12-19
Deactivation Code:
Reactivation Date:2020-01-15
Provider Licenses
StateLicense IDTaxonomies
AZ21088207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMD21088Medicare ID - Type Unspecified
AZF44220Medicare UPIN