Provider Demographics
NPI:1265435051
Name:BOWLES, FREDERICK BLANCHARD (PA-C)
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:BLANCHARD
Last Name:BOWLES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1737
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89125-1737
Mailing Address - Country:US
Mailing Address - Phone:702-671-6845
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:4880 WYNN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-5406
Practice Address - Country:US
Practice Address - Phone:702-871-5005
Practice Address - Fax:702-873-9280
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV314363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q15303Medicare UPIN
NV101213Medicare PIN