Provider Demographics
NPI:1154482396
Name:BOWEN, CECIL JR (MD)
Entity Type:Individual
Prefix:
First Name:CECIL
Middle Name:
Last Name:BOWEN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1175
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92226-1175
Mailing Address - Country:US
Mailing Address - Phone:760-921-6488
Mailing Address - Fax:760-921-6399
Practice Address - Street 1:250 N 1ST ST
Practice Address - Street 2:PALO VERDE HOSPITAL
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1702
Practice Address - Country:US
Practice Address - Phone:760-921-5196
Practice Address - Fax:760-921-8674
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG666332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology