Provider Demographics
NPI:1962465914
Name:DOWELL, KEITH EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:EUGENE
Last Name:DOWELL
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 1:1414 KELVING WAY
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-3416
Mailing Address - Country:US
Mailing Address - Phone:979-532-8603
Mailing Address - Fax:
Practice Address - Street 1:2100 REGIONAL MEDICAL DR
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-9719
Practice Address - Country:US
Practice Address - Phone:979-532-1700
Practice Address - Fax:979-532-6791
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0326208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20019502OtherRAILROAD GBA - RAILROAD MEDICARE
TX117635603Medicaid
TX820597OtherBC/BS TX#
TXMDE0326TXOtherWORKERS COMPENSATION
TX20019502OtherRAILROAD GBA - RAILROAD MEDICARE
TXMDE0326TXOtherWORKERS COMPENSATION