Provider Demographics
NPI:1487199071
Name:BOWMAN, GARY WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:WAYNE
Last Name:BOWMAN
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 1:16501 N EL MIRAGE RD
Mailing Address - Street 2:240
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-3600
Mailing Address - Country:US
Mailing Address - Phone:469-964-1960
Mailing Address - Fax:
Practice Address - Street 1:16501 N EL MIRAGE RD
Practice Address - Street 2:240
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-3600
Practice Address - Country:US
Practice Address - Phone:469-964-1960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5922207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology