Provider Demographics
NPI:1407855992
Name:DOWLING, GERALD LEE (DPM)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:LEE
Last Name:DOWLING
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 S COLUMBIAN ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2906
Mailing Address - Country:US
Mailing Address - Phone:989-686-2331
Mailing Address - Fax:989-686-4493
Practice Address - Street 1:316 S COLUMBIAN ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2906
Practice Address - Country:US
Practice Address - Phone:989-686-2331
Practice Address - Fax:989-686-4493
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2011-10-20
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-22
Provider Licenses
StateLicense IDTaxonomies
MIGD000703213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1380728Medicaid
MI1093907669OtherBLUE CARE NETWORK ADVANTAGE
MIT33924Medicare UPIN
MI0542410001Medicare NSC
0N35450Medicare PIN