Provider Demographics
NPI:1750379194
Name:DOWDEN, G BLAIR III (MD)
Entity type:Individual
Prefix:DR
First Name:G
Middle Name:BLAIR
Last Name:DOWDEN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BEAU
Other - Middle Name:
Other - Last Name:DOWDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4071 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3801
Mailing Address - Country:US
Mailing Address - Phone:810-824-4222
Mailing Address - Fax:810-824-4220
Practice Address - Street 1:4071 24TH AVE
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3801
Practice Address - Country:US
Practice Address - Phone:810-824-4222
Practice Address - Fax:810-824-4220
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088847207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0740206OtherBCBSM
MI0741095OtherBCBS
MI1750379194Medicaid
MI0740206OtherBCBSM
MIMI4469001Medicare PIN
MIG46040098Medicare PIN