Provider Demographics
NPI:1699831420
Name:BOWIE, CONSTANCE R (MD)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:R
Last Name:BOWIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5040
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95150
Mailing Address - Country:US
Mailing Address - Phone:408-947-2995
Mailing Address - Fax:408-947-2687
Practice Address - Street 1:2105 FOREST AVE
Practice Address - Street 2:OCONNOR HOSPITAL
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:408-947-2995
Practice Address - Fax:408-947-2687
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG685492085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G685490Medicaid
CA920004836OtherRAILROAD MEDICARE
F45379Medicare UPIN
CA00G685490Medicaid