Provider Demographics
NPI:1821141557
Name:BOWEN, SAMARA R (MD)
Entity Type:Individual
Prefix:
First Name:SAMARA
Middle Name:R
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 JOE BATTLE BLVD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-2622
Mailing Address - Country:US
Mailing Address - Phone:773-991-2336
Mailing Address - Fax:
Practice Address - Street 1:3280 JOE BATTLE BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2622
Practice Address - Country:US
Practice Address - Phone:773-991-2336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9817207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1687212-01Medicaid
TX8R0081OtherBLUE CROSS BLUE SHIELD
TX7890672OtherAETNA
TX8958143OtherCIGNA
TXP00232589OtherRAILROAD MEDICARE
TX8R0081OtherBLUE CROSS BLUE SHIELD
TX7890672OtherAETNA