Provider Demographics
NPI:1336188937
Name:BOWEN, DINA M (MD)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:M
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 COMMONS CIR
Mailing Address - Street 2:STE B
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-9524
Mailing Address - Country:US
Mailing Address - Phone:405-577-6700
Mailing Address - Fax:405-577-6705
Practice Address - Street 1:1804 COMMONS CIR
Practice Address - Street 2:STE B
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-9524
Practice Address - Country:US
Practice Address - Phone:405-577-6700
Practice Address - Fax:405-577-6705
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK19495208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100091540BMedicaid