Provider Demographics
NPI:1932129418
Name:COWELL, VERNON L (MD)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:L
Last Name:COWELL
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 1:25500 SE STARK ST STE 101
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-8327
Mailing Address - Country:US
Mailing Address - Phone:503-667-4000
Mailing Address - Fax:360-254-3719
Practice Address - Street 1:25500 SE STARK ST STE 101
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-8327
Practice Address - Country:US
Practice Address - Phone:503-667-4000
Practice Address - Fax:360-254-3719
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20828208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150464Medicaid
OR113548Medicare ID - Type UnspecifiedMEDICARE
OR150464Medicaid