Basic Information
| Provider Information | |||||||||
| NPI: | 1962489104 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCGOWAN | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1302 N. STATE HWY 91 | ||||||||
| Address2: | |||||||||
| City: | DENISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750201167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034651857 | ||||||||
| FaxNumber: | 9033278023 | ||||||||
| Practice Location | |||||||||
| Address1: | 5016 S. US HWY 75 | ||||||||
| Address2: | RADIOLOGY DEPT | ||||||||
| City: | DENISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034164000 | ||||||||
| FaxNumber: | 9033278023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2005 | ||||||||
| LastUpdateDate: | 06/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | K0927 | TX | N | Other Service Providers | Specialist | 2085R0202X | DR.0067721 | CO | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | K0927 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.