Provider Demographics
NPI:1336204569
Name:BOWMAN, MICHAEL DEWITT (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DEWITT
Last Name:BOWMAN
Suffix:
Gender:M
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:PO BOX 850547
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36685-0547
Mailing Address - Country:US
Mailing Address - Phone:251-633-8830
Mailing Address - Fax:
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE B216
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:261-633-8830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16336174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF06794Medicare UPIN
ALK013Medicare ID - Type Unspecified