Provider Demographics
NPI:1477555043
Name:BOWMAN, J RUSSELL (DO, MS, MHA)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:RUSSELL
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:DO, MS, MHA
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-1103
Mailing Address - Fax:720-718-0994
Practice Address - Street 1:8540 SCARBOROUGH DR STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7518
Practice Address - Country:US
Practice Address - Phone:719-364-6970
Practice Address - Fax:719-365-7667
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK4928207Q00000X
CODR.0061591207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD08671Medicaid
AKMD08671Medicaid
AKE93358Medicare UPIN
AK8ED901Medicare PIN