# DR. BLAKE WILLIAM MCGOWAN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1174518229
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | E4101 | AR | Yes |

## Other

- **Enumeration date:** 09/14/2005
- **Last updated:** 01/26/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01-01185 | UNITED HEALTHCARE | AR |
| 01 | — | 04080013400 | QUALCHOICE | AR |
| 01 | — | P00168487 | RALROAD MEDICARE | — |