Provider Demographics
NPI:1366491284
Name:BOWLAND, MARK B (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:B
Last Name:BOWLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 34717
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-4717
Mailing Address - Country:US
Mailing Address - Phone:210-615-1187
Mailing Address - Fax:210-614-2180
Practice Address - Street 1:4242 MEDICAL DR
Practice Address - Street 2:SUITE 3100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5640
Practice Address - Country:US
Practice Address - Phone:210-615-1187
Practice Address - Fax:210-614-2180
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL6297207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1605156-01Medicaid
TX1605156-01Medicaid