Provider Demographics
NPI:1184698912
Name:BOWEN, RONALD W (DO)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:W
Last Name:BOWEN
Suffix:
Gender:M
Credentials:DO
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 181197
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78480-1197
Mailing Address - Country:US
Mailing Address - Phone:361-985-9503
Mailing Address - Fax:361-985-6981
Practice Address - Street 1:5525 S STAPLES ST STE B1
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5371
Practice Address - Country:US
Practice Address - Phone:361-985-9503
Practice Address - Fax:361-985-6981
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127859004Medicaid
TX00QM65Medicare PIN
TX127859004Medicaid