Provider Demographics
NPI:1003121542
Name:BOWMAN, JIMMY ALLEN
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:ALLEN
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N COURTENAY PKWY
Mailing Address - Street 2:STE 2
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4501
Mailing Address - Country:US
Mailing Address - Phone:321-631-3155
Mailing Address - Fax:321-638-8684
Practice Address - Street 1:950 N COURTENAY PKWY
Practice Address - Street 2:STE 2
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4501
Practice Address - Country:US
Practice Address - Phone:321-631-3155
Practice Address - Fax:321-638-8684
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12232122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist