Provider Demographics
NPI:1821290131
Name:BOWLING, DONALD BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:BRUCE
Last Name:BOWLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-1238
Mailing Address - Country:US
Mailing Address - Phone:757-569-6100
Mailing Address - Fax:757-653-2066
Practice Address - Street 1:100 FAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-1238
Practice Address - Country:US
Practice Address - Phone:757-569-6100
Practice Address - Fax:757-653-2066
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA200065616 001OtherTRICARE
VA1821290131Medicaid
VA1821290131OtherANTHEM BCBS
VA1821290131OtherANTHEM BCBS
VA1821290131Medicaid