Provider Demographics
NPI:1871810069
Name:BOWDEN-MCKAY, CRYSTAL MELANIE (MD)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MELANIE
Last Name:BOWDEN-MCKAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12701 RR 620 N
Mailing Address - Street 2:STE 101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1141
Mailing Address - Country:US
Mailing Address - Phone:512-593-6022
Mailing Address - Fax:512-599-9130
Practice Address - Street 1:1401 MEDICAL PARKWAY
Practice Address - Street 2:BLDG. B, SUITE 211
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-5013
Practice Address - Country:US
Practice Address - Phone:512-260-1581
Practice Address - Fax:512-406-7309
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP6785207R00000X, 207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX328450703Medicaid
TX328450704Medicaid