Provider Demographics
NPI:1063637577
Name:BOWLIN, PAUL RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:RICHARD
Last Name:BOWLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 CHICAGO AVE STE 550
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4293
Mailing Address - Country:US
Mailing Address - Phone:612-813-8006
Mailing Address - Fax:
Practice Address - Street 1:2530 CHICAGO AVE STE 550
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4293
Practice Address - Country:US
Practice Address - Phone:612-813-8006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0437820208800000X
MO2015008288208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology