Provider Demographics
NPI:1447224852
Name:BOWEN, ROBERT EMERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EMERSON
Last Name:BOWEN
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 1:5047 N HWY A1A APT 1502
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34949-8238
Mailing Address - Country:US
Mailing Address - Phone:772-332-4420
Mailing Address - Fax:
Practice Address - Street 1:1001 N HWY US1
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950
Practice Address - Country:US
Practice Address - Phone:772-332-4420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042626E207K00000X
NY190864-1207K00000X
FLME110220207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011485140001Medicaid
PA040015199OtherRR MEDICARE PIN
PACC9269OtherRR MEDICARE GROUP
NY01111760Medicaid
PA0011485140001Medicaid
PA040015199OtherRR MEDICARE PIN