Individual
MATTHEW BRYAN GOWEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AG-ACNP
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 593-8441
Mailing address
800 E DAWSON ST, TYLER, TX 75701-2036
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
AP138644
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
390463302
—
TX
01
—
P02230213
MEDICARE RAIL ROAD
TX
Enumeration date
08/30/2018
Last updated
07/01/2019
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