Provider Demographics
NPI:1699858282
Name:BOWDEN, MARY TALLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:TALLEY
Last Name:BOWDEN
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 1:1740 W 27TH ST
Mailing Address - Street 2:SUITE 234
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1440
Mailing Address - Country:US
Mailing Address - Phone:713-802-9779
Mailing Address - Fax:713-802-2289
Practice Address - Street 1:3600 KIRBY DR STE F
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3941
Practice Address - Country:US
Practice Address - Phone:713-492-2340
Practice Address - Fax:713-510-1912
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9770207Y00000X, 207YX0007X, 207YS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J9960OtherBLUE CROSS BLUE SHIELD
H87955Medicare UPIN
TX8J9960OtherBLUE CROSS BLUE SHIELD