Provider Demographics
NPI:1962480897
Name:MCGOWAN, JOHN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:MCGOWAN
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 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W STE 210
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4748
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKMEDS60022085R0202X
IDM-123272085R0202X
WAMD000433872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0204114OtherLNI-SWEDISH RADIA EDMONDS
WA0377930OtherLNI-RADIA KING COUNTY
WA0385222OtherLNI-SOUTH SOUND RADIOLOGY
ID1962480897Medicaid
WA8392599Medicaid
AK1010167Medicaid
WA0184785OtherLNI-EVERGREEN RADIA
WA0184787OtherLNI-RADIA REST OF WA
P00141363Medicare PIN
WA8862856Medicare PIN
WA8802533Medicare PIN
WA184787OtherL&I PROVIDER NUMBER
P00359923Medicare PIN
WA184785OtherL&I PROVIDER NUMBER
P00266855Medicare PIN
WA8802535Medicare PIN
WA8802531Medicare PIN
ID20004420Medicare PIN
WA184786OtherL&I PROVIDER NUMBER