Provider Demographics
NPI:1336185362
Name:BOWDISH, GAIL E (MD)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:E
Last Name:BOWDISH
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 1:411 WALNUT ST
Mailing Address - Street 2:PMB 9138
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-3443
Mailing Address - Country:US
Mailing Address - Phone:616-402-1505
Mailing Address - Fax:
Practice Address - Street 1:502 E SECOND ST
Practice Address - Street 2:ESSENTIA HEALTH
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805
Practice Address - Country:US
Practice Address - Phone:218-786-8364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI073150207P00000X
MN35905207P00000X
NE23512207P00000X
WI39266207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4150898Medicaid
MIF46623Medicare UPIN