Provider Demographics
NPI:1720042104
Name:BOWEN, ELTON C (MD)
Entity Type:Individual
Prefix:MR
First Name:ELTON
Middle Name:C
Last Name:BOWEN
Suffix:
Gender:M
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 26289
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-6289
Mailing Address - Country:US
Mailing Address - Phone:480-756-6000
Mailing Address - Fax:480-467-2165
Practice Address - Street 1:9440 E. IRONWOOD SQUARE DR.
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4569
Practice Address - Country:US
Practice Address - Phone:480-756-6000
Practice Address - Fax:480-467-2165
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28112207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ499302Medicaid
Z173490Medicare PIN
AZH11336Medicare UPIN