Provider Demographics
NPI:1184670903
Name:BOWMAN, PAUL H (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:H
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5379 PRIMROSE LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3521
Mailing Address - Country:US
Mailing Address - Phone:813-977-2040
Mailing Address - Fax:813-977-3886
Practice Address - Street 1:5379 PRIMROSE LAKE CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3521
Practice Address - Country:US
Practice Address - Phone:813-977-2040
Practice Address - Fax:813-977-3886
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90592207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46698OtherBLUE CROSS BLUE SHIELD
FLK6612Medicare ID - Type Unspecified
FL46698OtherBLUE CROSS BLUE SHIELD