Provider Demographics
NPI:1649249277
Name:BOWMAN, PHILIP J
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:J
Last Name:BOWMAN
Suffix:
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 1:3201 W PEORIA AVE
Mailing Address - Street 2:STE A105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4608
Mailing Address - Country:US
Mailing Address - Phone:602-841-9720
Mailing Address - Fax:602-841-9794
Practice Address - Street 1:3201 W PEORIA AVE
Practice Address - Street 2:STE A105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4608
Practice Address - Country:US
Practice Address - Phone:602-841-9720
Practice Address - Fax:602-841-9794
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1506207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ20WCHML01Medicare PIN
E84584Medicare UPIN