Provider Demographics
NPI:1295108124
Name:BOWMAN, JEFFERY JR
Entity type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:
Last Name:BOWMAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 CHELCIE ST
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-8263
Mailing Address - Country:US
Mailing Address - Phone:949-606-6796
Mailing Address - Fax:
Practice Address - Street 1:THIRD MARINE LOGISTICS GROUP
Practice Address - Street 2:UNIT 38404
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96604-8404
Practice Address - Country:US
Practice Address - Phone:01181611-737-1829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman