Provider Demographics
NPI:1841241007
Name:BOWMAN, CORINE H (MD)
Entity Type:Individual
Prefix:
First Name:CORINE
Middle Name:H
Last Name:BOWMAN
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:PO BOX 52364
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71135-2364
Mailing Address - Country:US
Mailing Address - Phone:318-798-4539
Mailing Address - Fax:318-798-4601
Practice Address - Street 1:1007 GOULD DR BUILDING 3
Practice Address - Street 2:SUITE 4
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-4971
Practice Address - Country:US
Practice Address - Phone:318-584-7319
Practice Address - Fax:318-584-7322
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1486493Medicaid
LA5E727C848Medicare PIN
LA561228ZYY7Medicare PIN
LA5E727Medicare PIN
LA1486493Medicaid
LA5E727CJ83Medicare PIN