Provider Demographics
NPI:1114358710
Name:JOHN W BOWMAN MD LLC
Entity Type:Organization
Organization Name:JOHN W BOWMAN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-505-6826
Mailing Address - Street 1:8678 EDGEHILL DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-3786
Mailing Address - Country:US
Mailing Address - Phone:256-505-6826
Mailing Address - Fax:256-582-1100
Practice Address - Street 1:4810 WHITESPORT CIR SW
Practice Address - Street 2:SUITE 105
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-7419
Practice Address - Country:US
Practice Address - Phone:256-429-5390
Practice Address - Fax:256-429-5933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10852208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1093808826OtherINDIVIDUAL NPI