Provider Demographics
NPI:1760647184
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:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:THORPE
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 STE 340
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3020
Mailing Address - Country:US
Mailing Address - Phone:626-796-5325
Mailing Address - Fax:626-796-5526
Practice Address - Street 1:10 CONGRESS ST STE 340
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3020
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:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24388332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A248331Medicaid
A24388Medicare PIN
A23958Medicare UPIN
CA00A248331Medicaid