Provider Demographics
NPI:1124058672
Name:COWLEY, SHIRL CURTIS (DPM)
Entity type:Individual
Prefix:
First Name:SHIRL
Middle Name:CURTIS
Last Name:COWLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 SOUTH MAIN
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770
Mailing Address - Country:US
Mailing Address - Phone:435-628-2671
Mailing Address - Fax:435-634-1601
Practice Address - Street 1:754 SOUTH MAIN
Practice Address - Street 2:SUITE 3
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:435-628-2671
Practice Address - Fax:435-634-1601
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1032980501213E00000X
UT103298-0501213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5530705Medicare ID - Type Unspecified
UT005530705Medicare PIN
T48828Medicare UPIN