Provider Demographics
NPI:1558320283
Name:BOWRON, CRAIG L (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:L
Last Name:BOWRON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:MR10809
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-0043
Mailing Address - Country:US
Mailing Address - Phone:612-262-4813
Mailing Address - Fax:612-262-4194
Practice Address - Street 1:920 E 28TH ST
Practice Address - Street 2:SUITE 190
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1139
Practice Address - Country:US
Practice Address - Phone:612-863-1893
Practice Address - Fax:612-863-3809
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2015-04-02
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Provider Licenses
StateLicense IDTaxonomies
MN36478207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN118325700Medicaid
MN118325700Medicaid