Provider Demographics
NPI:1750391546
Name:COWART, ROGER W (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:W
Last Name:COWART
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:PO BOX 18962
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4084
Mailing Address - Country:US
Mailing Address - Phone:800-566-5050
Mailing Address - Fax:254-537-6201
Practice Address - Street 1:7005 WOODWAY DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7924
Practice Address - Country:US
Practice Address - Phone:254-776-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1218207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF30567Medicare UPIN
TX00J67EMedicare PIN
TX87W358Medicare PIN