Provider Demographics
NPI:1689987505
Name:GERALD T. BOWNS, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:GERALD T. BOWNS, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:GERALD T. BOWNS, M.D., INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:T
Authorized Official - Last Name:BOWNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-796-5325
Mailing Address - Street 1:10 CONGRESS ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3045
Mailing Address - Country:US
Mailing Address - Phone:626-796-5325
Mailing Address - Fax:626-796-5526
Practice Address - Street 1:10 CONGRESS ST
Practice Address - Street 2:SUITE 340
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3045
Practice Address - Country:US
Practice Address - Phone:626-796-5325
Practice Address - Fax:626-796-5526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24388261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A248331Medicaid
CAA24388Medicare PIN
CA4697820001Medicare NSC
CA00A248331Medicaid