Provider Demographics
NPI:1811029507
Name:BOWMAN, KENDRA G (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:G
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E IDAHO ST
Mailing Address - Street 2:STE. 300
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6267
Mailing Address - Country:US
Mailing Address - Phone:208-381-7370
Mailing Address - Fax:
Practice Address - Street 1:100 E IDAHO ST
Practice Address - Street 2:STE. 300
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6267
Practice Address - Country:US
Practice Address - Phone:208-381-7370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA245014208600000X, 390200000X
MI4301087754390200000X
WI62401-20208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program