Provider Demographics
NPI:1376725176
Name:BOWE, REGINA (MD MPH)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:BOWE
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39649-0490
Mailing Address - Country:US
Mailing Address - Phone:601-249-2142
Mailing Address - Fax:601-249-1794
Practice Address - Street 1:1506 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2716
Practice Address - Country:US
Practice Address - Phone:601-249-2142
Practice Address - Fax:601-249-1794
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPGY.1.TUL-MED/P208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1002607Medicaid
MS302I110053Medicare PIN