Provider Demographics
NPI:1922110238
Name:BOWMAN, GLEN (MD)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:
Last Name:BOWMAN
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:PO BOX 33285
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95031-3285
Mailing Address - Country:US
Mailing Address - Phone:408-354-9254
Mailing Address - Fax:918-213-4399
Practice Address - Street 1:1900 SULLIVAN AVE
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2200
Practice Address - Country:US
Practice Address - Phone:408-354-9254
Practice Address - Fax:918-213-4399
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT319122-1205207L00000X
CAG185046207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806868300Medicaid
UT835388OtherHEALTHY U
UT77515OtherPEHP
UTQM0000075886OtherALTIUS
UT870545614BOWOtherEDUCATORS MUTUAL
UTTPRA09326OtherMOLINA
UT2090168OtherUNITED HEALTHCARE
NV100503208Medicaid
UT1502954OtherUMWA
AZ858409Medicaid
UT107028042101OtherIHC
WY119647200Medicaid
UT851001OtherDESERET MUTUAL
UT835388OtherHEALTHY U
UT055327133Medicare ID - Type Unspecified
UTH08342Medicare UPIN