Provider Demographics
NPI:1558380477
Name:BOWDEN, DOUGLAS EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:EDWARD
Last Name:BOWDEN
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 1:501 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-4237
Mailing Address - Country:US
Mailing Address - Phone:662-453-4641
Mailing Address - Fax:662-455-4731
Practice Address - Street 1:501 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-4237
Practice Address - Country:US
Practice Address - Phone:662-453-4641
Practice Address - Fax:662-455-4731
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13107208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00112065Medicaid
MS00112065Medicaid
MS0200000242Medicare ID - Type Unspecified