Provider Demographics
NPI:1306020904
Name:BOWMAN, JAMES C (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
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 1:13245 KESSLER RD
Mailing Address - Street 2:PO BOX 233
Mailing Address - City:CAIRO
Mailing Address - State:IL
Mailing Address - Zip Code:62914-3101
Mailing Address - Country:US
Mailing Address - Phone:618-734-4400
Mailing Address - Fax:
Practice Address - Street 1:226 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ROSICLARE
Practice Address - State:IL
Practice Address - Zip Code:62982
Practice Address - Country:US
Practice Address - Phone:618-285-3930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019021859122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019021859Medicaid