Provider Demographics
NPI:1114132503
Name:BOWEN, LARRY HOWARD LEE (ARRT(R) EMT(B))
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:HOWARD LEE
Last Name:BOWEN
Suffix:
Gender:M
Credentials:ARRT(R) EMT(B)
Other - Prefix:
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Mailing Address - Street 1:599 TOMALES RD
Mailing Address - Street 2:HEALTH SERVICES 'A' SCHOOL
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-5002
Mailing Address - Country:US
Mailing Address - Phone:707-765-7488
Mailing Address - Fax:707-765-7495
Practice Address - Street 1:599 TOMALES RD
Practice Address - Street 2:HEALTH SERVICES 'A' SCHOOL
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-5002
Practice Address - Country:US
Practice Address - Phone:707-765-7488
Practice Address - Fax:707-765-7495
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
3583212471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography