Provider Demographics
NPI:1457397762
Name:BOWMAN, CHARLES BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:BRADLEY
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 730486
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-0486
Mailing Address - Country:US
Mailing Address - Phone:214-692-0146
Mailing Address - Fax:214-692-1698
Practice Address - Street 1:10740 N CENTRAL EXPY
Practice Address - Street 2:SUITE 350
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2161
Practice Address - Country:US
Practice Address - Phone:214-692-0146
Practice Address - Fax:214-692-1698
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6076207WX0120X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8X1371OtherBCBS
TX135801209Medicaid
TX135801210Medicaid
TX8F4280Medicare PIN
TXF60617Medicare UPIN
TX135801210Medicaid
TXP00382409Medicare PIN