Provider Demographics
NPI:1861534828
Name:MCKOWEN, ROBERT L (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:MCKOWEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12121 RICHMOND AVE
Mailing Address - Street 2:SUITE 325
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2432
Mailing Address - Country:US
Mailing Address - Phone:281-496-1700
Mailing Address - Fax:281-496-9081
Practice Address - Street 1:12121 RICHMOND AVE
Practice Address - Street 2:SUITE 325
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2432
Practice Address - Country:US
Practice Address - Phone:281-496-1700
Practice Address - Fax:281-496-9081
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH15152086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128004204Medicaid
TX82Y400Medicare PIN
TXC19185Medicare UPIN