Provider Demographics
NPI:1548262710
Name:MCGOWEN, JEFFREY L (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:MCGOWEN
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 1:6301 HARRIS PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4249
Mailing Address - Country:US
Mailing Address - Phone:817-877-3432
Mailing Address - Fax:817-346-4394
Practice Address - Street 1:6301 HARRIS PKWY STE 300
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4249
Practice Address - Country:US
Practice Address - Phone:817-877-3432
Practice Address - Fax:817-346-4394
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8833207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181787603Medicaid
TX8P6302OtherBLUE CROSS/BLUE SHIELD
TXL8833OtherSTATE LICENSE
TX8C1087Medicare PIN
TX8P6302OtherBLUE CROSS/BLUE SHIELD
TXI13868Medicare UPIN