Provider Demographics
NPI:1336299098
Name:BOWEN, MICHAEL LAWRENCE (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LAWRENCE
Last Name:BOWEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:545 E REDD RD
Mailing Address - Street 2:SUITE C2
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1293
Mailing Address - Country:US
Mailing Address - Phone:915-298-1008
Mailing Address - Fax:915-298-1009
Practice Address - Street 1:545 E REDD RD
Practice Address - Street 2:SUITE C-2
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-1293
Practice Address - Country:US
Practice Address - Phone:915-298-1008
Practice Address - Fax:915-298-1009
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2013-09-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM6539208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3100802-02Medicaid