Provider Demographics
NPI:1922696509
Name:COWLES, THOMAS SPENCER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:SPENCER
Last Name:COWLES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9190 OAK LEAF WAY
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-8913
Mailing Address - Country:US
Mailing Address - Phone:916-203-4942
Mailing Address - Fax:
Practice Address - Street 1:9190 OAK LEAF WAY
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-8913
Practice Address - Country:US
Practice Address - Phone:916-203-4942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA59034363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant