Provider Demographics
NPI:1114007085
Name:BOWLING, RICHARD LEE (PA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEE
Last Name:BOWLING
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 J ST
Mailing Address - Street 2:STE. 370
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3631
Mailing Address - Country:US
Mailing Address - Phone:916-453-2800
Mailing Address - Fax:916-453-2804
Practice Address - Street 1:3939 J ST
Practice Address - Street 2:STE. 370
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3631
Practice Address - Country:US
Practice Address - Phone:916-453-2800
Practice Address - Fax:916-453-2804
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17669363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX58571Medicaid
ZZZ05946ZOtherGROUP PTAN
ZZZ05946ZOtherGROUP PTAN
0PA176691Medicare PIN