Provider Demographics
NPI:1578233128
Name:BOWEN, ROGER DALE
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:DALE
Last Name:BOWEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 W PARADISE RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-9642
Mailing Address - Country:US
Mailing Address - Phone:509-540-0412
Mailing Address - Fax:
Practice Address - Street 1:1118 W PARADISE RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-9642
Practice Address - Country:US
Practice Address - Phone:509-540-0412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care