Provider Demographics
NPI:1922186733
Name:DOWELL, MARK EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:DOWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1450 E A ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2239
Mailing Address - Country:US
Mailing Address - Phone:307-234-8700
Mailing Address - Fax:307-234-8750
Practice Address - Street 1:1450 E A ST STE 1
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2239
Practice Address - Country:US
Practice Address - Phone:307-234-8700
Practice Address - Fax:307-234-8750
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5197A207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY114291700Medicaid
WY114291700Medicaid
WYB22353Medicare UPIN