Provider Demographics
NPI:1841221413
Name:DOWELL, DAVID A (DPM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:DOWELL
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S KEENE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-7199
Mailing Address - Country:US
Mailing Address - Phone:573-443-2402
Mailing Address - Fax:
Practice Address - Street 1:1 S KEENE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7199
Practice Address - Country:US
Practice Address - Phone:573-443-2402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS266213E00000X
TN791213E00000X
MO000709213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1841221413Medicaid
TNQ030042Medicaid
MO112888OtherBCBS
MO307642520Medicaid
KSKA4189001Medicare PIN
MOMA3446192Medicare PIN
MOU50514Medicare UPIN
MO307642520Medicaid
KSKA1575038Medicare PIN
TNQ030042Medicaid
KS015066Medicare PIN
MO480018249Medicare PIN
MO307642520Medicaid
MO000021286Medicare PIN
MOMO0101OtherJOHN DEERE HEALTHCARE