Provider Demographics
NPI:1255933370
Name:BOWEN, DEBRA LOUISE (MD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:LOUISE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 WAKE FOREST RD STE 349
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-0010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:254 METHODIST DR
Practice Address - Street 2:
Practice Address - City:LAKE JUNALUSKA
Practice Address - State:NC
Practice Address - Zip Code:28745-8789
Practice Address - Country:US
Practice Address - Phone:828-456-9039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-073163-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine