| Jennifer A Dowalter Md A Professional Corporation | |
|
15630 18th Ave Clearlake CA 95422-9336 | |
| (702) 453-3799 | |
| (702) 453-5741 |
| Full Name | Jennifer A Dowalter Md A Professional Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 15630 18th Ave, Clearlake, California |
| Authorized Official Name and Position | Jennifer H Dowalter (SOLE OWNER) |
| Authorized Official Contact | 9492924082 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jennifer A Dowalter Md A Professional Corporation Po Box 105 Mountain Center CA 92561-0105 Ph: (702) 453-3799 | Jennifer A Dowalter Md A Professional Corporation 15630 18th Ave Clearlake CA 95422-9336 Ph: (702) 453-3799 |
| NPI Number | 1811362585 |
|---|---|
| Provider Enumeration Date | 12/07/2015 |
| Last Update Date | 12/07/2015 |
| Medicare PECOS PAC ID | 4981907896 |
|---|---|
| Medicare Enrollment ID | O20160127001811 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811362585 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A96391 (California) | Primary |
| Provider Name | Jennifer A Dowalter |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285660233 PECOS PAC ID: 2062417231 Enrollment ID: I20061005000530 |
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