Provider Demographics
NPI:1720645153
Name:BRIAN A. MCDOWELL PODIATRY CORPORATION
Entity Type:Organization
Organization Name:BRIAN A. MCDOWELL PODIATRY CORPORATION
Other - Org Name:PREMIER PODIATRY & ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:RIPP
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:916-961-3434
Mailing Address - Street 1:6620 COYLE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6337
Mailing Address - Country:US
Mailing Address - Phone:916-961-3434
Mailing Address - Fax:916-961-0584
Practice Address - Street 1:6620 COYLE AVE STE 202
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6337
Practice Address - Country:US
Practice Address - Phone:916-961-3434
Practice Address - Fax:916-961-0584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty