Provider Demographics
NPI:1952583197
Name:MACDOWELL, TOM RICHARD
Entity Type:Individual
Prefix:MR
First Name:TOM
Middle Name:RICHARD
Last Name:MACDOWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 RODMAN DR
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-4324
Mailing Address - Country:US
Mailing Address - Phone:805-772-8210
Mailing Address - Fax:
Practice Address - Street 1:358 QUINTANA RD
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-2054
Practice Address - Country:US
Practice Address - Phone:805-772-8210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102773332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03097FMedicaid
CADME03097FMedicaid
CA0492990001Medicare NSC