Provider Demographics
NPI:1689688111
Name:BOWEN, STEPHEN R (PHD, MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:BOWEN
Suffix:
Gender:M
Credentials:PHD, 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 1:209 W SPRING ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2973
Mailing Address - Country:US
Mailing Address - Phone:256-245-5241
Mailing Address - Fax:256-245-0194
Practice Address - Street 1:209 W SPRING ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2973
Practice Address - Country:US
Practice Address - Phone:256-245-5241
Practice Address - Fax:256-245-0194
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10458207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL110229290OtherRAILROAD MEDICARE
AL51075938OtherBLUE CROSS
AL009971300Medicaid
AL51075938OtherBLUE CROSS
AL00075938Medicare ID - Type Unspecified