Provider Demographics
NPI:1235326729
Name:BOWMAN, GERALD DAVID (CO)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:DAVID
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19231 VICTORY BLVD
Mailing Address - Street 2:STE 350
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6308
Mailing Address - Country:US
Mailing Address - Phone:818-996-1611
Mailing Address - Fax:818-996-1612
Practice Address - Street 1:19231 VICTORY BLVD
Practice Address - Street 2:STE 350
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6308
Practice Address - Country:US
Practice Address - Phone:818-996-1611
Practice Address - Fax:818-996-1612
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6118650002Medicare NSC