Provider Demographics
NPI:1114403219
Name:BOWEN, ORIS GEROME
Entity Type:Individual
Prefix:
First Name:ORIS
Middle Name:GEROME
Last Name:BOWEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 CEDAR ASH XING
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-2347
Mailing Address - Country:US
Mailing Address - Phone:615-418-0322
Mailing Address - Fax:
Practice Address - Street 1:5709 CEDAR ASH XING
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-2347
Practice Address - Country:US
Practice Address - Phone:615-600-1217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN203150344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi