Provider Demographics
NPI:1821027228
Name:BOWEN, DAVID T (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:T
Last Name:BOWEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:72650 FRED WARING DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-5006
Mailing Address - Country:US
Mailing Address - Phone:760-837-7200
Mailing Address - Fax:760-837-7201
Practice Address - Street 1:72650 FRED WARING DR
Practice Address - Street 2:SUITE 109
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-5006
Practice Address - Country:US
Practice Address - Phone:760-837-7200
Practice Address - Fax:760-837-7201
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA60193208200000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA240007820OtherRRMCR
CAWA60193AMedicare ID - Type Unspecified
CA240007820OtherRRMCR