Provider Demographics
NPI:1437115854
Name:BOWDEN, BRUCE A (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:BOWDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 BARKLEY BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-6614
Mailing Address - Country:US
Mailing Address - Phone:360-647-0220
Mailing Address - Fax:360-734-7588
Practice Address - Street 1:2075 BARKLEY BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6614
Practice Address - Country:US
Practice Address - Phone:360-647-0220
Practice Address - Fax:360-734-7588
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA19819174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1925403Medicaid
WA1925403Medicaid
WAGAB14231Medicare ID - Type Unspecified