Basic Information
| Provider Information | |||||||||
| NPI: | 1619900891 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEAN B DOW MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5109 | ||||||||
| Address2: | |||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976010119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418821540 | ||||||||
| FaxNumber: | 5418822583 | ||||||||
| Practice Location | |||||||||
| Address1: | 2850 DAGGETT AVE | ||||||||
| Address2: | |||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976011107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412056081 | ||||||||
| FaxNumber: | 5412056078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 07/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | DOW | ||||||||
| AuthorizedOfficialFirstName: | SEAN | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5412056081 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | MD18271 | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 057997 | 05 | OR | MEDICAID |