Provider Demographics
NPI:1093929036
Name:BOWEN, JON R (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:R
Last Name:BOWEN
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:PO BOX 4013
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508-4013
Mailing Address - Country:US
Mailing Address - Phone:304-855-1200
Mailing Address - Fax:304-855-1230
Practice Address - Street 1:386 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508-9202
Practice Address - Country:US
Practice Address - Phone:304-855-1200
Practice Address - Fax:304-855-1230
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22652207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2030992Medicare PIN
WVBO2030992Medicare PIN
WVBO2030991Medicare PIN
WV2030991Medicare PIN