Provider Demographics
NPI:1326070665
Name:BOWMAN, BRADLEY P (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:P
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:825 SE BISHOP BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5537
Mailing Address - Country:US
Mailing Address - Phone:509-332-2517
Mailing Address - Fax:509-334-9247
Practice Address - Street 1:3355 FOOTHILL RD
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-8765
Practice Address - Country:US
Practice Address - Phone:509-332-2517
Practice Address - Fax:509-334-9247
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807307400Medicaid
WA8431546Medicaid
I38410Medicare UPIN
WA8431546Medicaid