Individual
DR. BLAKE WILLIAM MCGOWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 S UNIVERSITY AVE, SUITE 808, LITTLE ROCK, AR 72205-5302
(501) 660-4484
(501) 660-4490
Mailing address
500 S UNIVERSITY AVE, SUITE 808, LITTLE ROCK, AR 72205-5302
(501) 660-4484
(501) 660-4490
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E4101
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-01185
UNITED HEALTHCARE
AR
01
—
04080013400
QUALCHOICE
AR
01
—
P00168487
RALROAD MEDICARE
—
Enumeration date
09/14/2005
Last updated
01/26/2021
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