Provider Demographics
NPI:1073621611
Name:BOWMAN, JANE C (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:C
Last Name:BOWMAN
Suffix:
Gender:F
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:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-233-4400
Mailing Address - Fax:801-233-4410
Practice Address - Street 1:3723 W 12600 S
Practice Address - Street 2:SUITE 360
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7295
Practice Address - Country:US
Practice Address - Phone:801-285-4700
Practice Address - Fax:801-285-4601
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1860261205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000068806Medicare PIN