Provider Demographics
NPI:1114216603
Name:BOWLING, JORDAN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:DAVID
Last Name:BOWLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JORDAN
Other - Middle Name:DAVID
Other - Last Name:BOWLING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4301 WATERBURY LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-1519
Mailing Address - Country:US
Mailing Address - Phone:402-730-0706
Mailing Address - Fax:
Practice Address - Street 1:575 S 70TH ST STE 435
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2463
Practice Address - Country:US
Practice Address - Phone:402-730-0706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE32138208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty