Basic Information
| Provider Information | |||||||||
| NPI: | 1568445500 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCEOWN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | ROBB | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 8475 E HARTFORD DR STE 201 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852555477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805919345 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6301 S MCCLINTOCK DR STE 115 | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852833393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807758460 | ||||||||
| FaxNumber: | 4807758464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2005 | ||||||||
| LastUpdateDate: | 08/10/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 12215 | AZ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | A1U1436 | 01 | AZ | HEALTHNET GRP # | OTHER | P00467103 | 01 | AZ | RAILROAD MEDICARE | OTHER | 860373636 | 01 | AZ | HUMANA GROUP # | OTHER | 234120 | 05 | AZ | MEDICAID | 453051001 | 01 | AZ | GROUP HEALTH GRP # | OTHER | 3981220 | 01 | AZ | EVERCARE GRP # | OTHER | AZ0728670 | 01 | AZ | BLUE CROSS BLUE SHIELD | OTHER |