Provider Demographics
NPI:1720369028
Name:BOWMAN, LEE (ATP)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5531 DONA ANA LOOP NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-5209
Mailing Address - Country:US
Mailing Address - Phone:505-206-2427
Mailing Address - Fax:877-238-4877
Practice Address - Street 1:3520 PAN AMERICAN HWY
Practice Address - Street 2:SUITE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107
Practice Address - Country:US
Practice Address - Phone:505-353-3797
Practice Address - Fax:877-238-4877
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMATP709247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM172004-2583Medicare UPIN