Basic Information
| Provider Information | |||||||||
| NPI: | 1184712101 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCGOWIN | ||||||||
| FirstName: | NORMAN | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 398 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 360370398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343826864 | ||||||||
| FaxNumber: | 3343826929 | ||||||||
| Practice Location | |||||||||
| Address1: | 45 MEDICAL ARTS CT STE 4 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 360373872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343826864 | ||||||||
| FaxNumber: | 3343826929 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 03/12/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 00009886 | AL | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 51086762 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER | 000086762 | 05 | AL | MEDICAID |