Provider Demographics
NPI:1679675268
Name:BOWEN, ZENOBIA (DPM)
Entity Type:Individual
Prefix:
First Name:ZENOBIA
Middle Name:
Last Name:BOWEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6632 GLENCOE DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TER
Mailing Address - State:FL
Mailing Address - Zip Code:33617-3801
Mailing Address - Country:US
Mailing Address - Phone:866-435-3668
Mailing Address - Fax:
Practice Address - Street 1:6632 GLENCOE DR
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-3801
Practice Address - Country:US
Practice Address - Phone:813-261-0382
Practice Address - Fax:813-261-0382
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP03055213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL188706OtherAMERIGROUP
FL340358100Medicaid
FL65807OtherBLUE CROSS BLUE SHIELD
FL65807OtherBLUE CROSS BLUE SHIELD
FLU78348Medicare UPIN
FLU0542Medicare PIN
FLP00086691Medicare PIN