Provider Demographics
NPI:1437873320
Name:BOWLES, RAYMOND DARVELL JR
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:DARVELL
Last Name:BOWLES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 E COTTON CENTER BLVD STE 39
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-8863
Mailing Address - Country:US
Mailing Address - Phone:602-334-1818
Mailing Address - Fax:
Practice Address - Street 1:4050 E COTTON CENTER BLVD STE 39
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-8863
Practice Address - Country:US
Practice Address - Phone:602-334-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP117382084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty