Provider Demographics
NPI:1952446361
Name:ROWELL, DAVID PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:ROWELL
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 1:1309 LIBERTY ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4245
Mailing Address - Country:US
Mailing Address - Phone:503-585-2022
Mailing Address - Fax:503-378-0797
Practice Address - Street 1:1309 LIBERTY ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4245
Practice Address - Country:US
Practice Address - Phone:503-585-2022
Practice Address - Fax:503-378-0797
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR32676207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR165456Medicaid
R0000WCGFNMedicare PIN
ORC90954Medicare UPIN