Provider Demographics
NPI:1104150606
Name:JEFFREY JAY COWAN MD INC & HEATHER MILLER MD INC A GENERAL PARTNERSHIP
Entity type:Organization
Organization Name:JEFFREY JAY COWAN MD INC & HEATHER MILLER MD INC A GENERAL PARTNERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-792-3914
Mailing Address - Street 1:4201 TORRANCE BLVD
Mailing Address - Street 2:600
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4504
Mailing Address - Country:US
Mailing Address - Phone:310-540-5503
Mailing Address - Fax:
Practice Address - Street 1:4201 TORRANCE BLVD
Practice Address - Street 2:600
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4504
Practice Address - Country:US
Practice Address - Phone:310-540-5503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG35295OtherMEDICAL LICENSE
CAA91708OtherMEDICAL LICENSE
CAG35295OtherMEDICAL LICENSE