Provider Demographics
NPI:1467813519
Name:BOWMAN, JON P (HIS)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:P
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15148 N BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:46124-9157
Mailing Address - Country:US
Mailing Address - Phone:812-371-5951
Mailing Address - Fax:812-526-2864
Practice Address - Street 1:309 E SOUTHVIEW DR
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-3351
Practice Address - Country:US
Practice Address - Phone:812-371-5951
Practice Address - Fax:812-526-2864
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001388A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist