Provider Demographics
NPI:1891059283
Name:BOWLES, RICHARD SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SCOTT
Last Name:BOWLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:3101 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2790
Practice Address - Country:US
Practice Address - Phone:904-737-1171
Practice Address - Fax:904-390-7493
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2022-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME122874207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01490352OtherRR MEDICARE
FLP01490352OtherRR MEDICARE