Provider Demographics
NPI:1205331329
Name:BOWEN, ANDREW JAY (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAY
Last Name:BOWEN
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 1:5201 OLD MIDDLETON RD APT 105
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2724
Mailing Address - Country:US
Mailing Address - Phone:760-803-2589
Mailing Address - Fax:
Practice Address - Street 1:5201 OLD MIDDLETON RD APT 105
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2724
Practice Address - Country:US
Practice Address - Phone:760-803-2589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29121207Y00000X
MN65805207Y00000X
WI81765-20207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology