Provider Demographics
NPI:1093921975
Name:BOWEN, BRIAN M (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:M
Last Name:BOWEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1717 NE 42ND AVE
Mailing Address - Street 2:SUITE 3300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1569
Mailing Address - Country:US
Mailing Address - Phone:503-284-2000
Mailing Address - Fax:503-284-2002
Practice Address - Street 1:1717 NE 42ND AVE
Practice Address - Street 2:SUITE 3300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1569
Practice Address - Country:US
Practice Address - Phone:503-284-2000
Practice Address - Fax:503-284-2002
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00435213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR165586Medicare PIN