Provider Demographics
NPI:1629569223
Name:BOWEN, TRAVIS PERRY (DO)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:PERRY
Last Name:BOWEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 SPRING HILL AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-1409
Mailing Address - Country:US
Mailing Address - Phone:251-435-2663
Mailing Address - Fax:
Practice Address - Street 1:1720 SPRING HILL AVE STE 301
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1409
Practice Address - Country:US
Practice Address - Phone:251-435-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-20
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.2629207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty