Provider Demographics
NPI:1639164650
Name:BOWLEY, STEVEN JON (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JON
Last Name:BOWLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 N 32ND ST
Mailing Address - Street 2:STE C
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-4746
Mailing Address - Country:US
Mailing Address - Phone:602-956-6559
Mailing Address - Fax:602-956-6834
Practice Address - Street 1:4202 N 32ND ST
Practice Address - Street 2:STE C
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-4746
Practice Address - Country:US
Practice Address - Phone:602-956-6559
Practice Address - Fax:602-956-6834
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9462207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E00251Medicare UPIN