Provider Demographics
NPI:1902020241
Name:CECIL D BOWEN JR, MD A PROFRSSIONAL CORPORATION
Entity Type:Organization
Organization Name:CECIL D BOWEN JR, MD A PROFRSSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:760-861-0432
Mailing Address - Street 1:PO BOX 1175
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92226-1175
Mailing Address - Country:US
Mailing Address - Phone:760-861-0432
Mailing Address - Fax:760-921-8674
Practice Address - Street 1:250 N 1ST ST
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1702
Practice Address - Country:US
Practice Address - Phone:760-921-5202
Practice Address - Fax:760-921-8674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG666332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ30333ZMedicare ID - Type Unspecified