Provider Demographics
NPI:1669580668
Name:BOWDEN, MARK D (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:BOWDEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:31075 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34602-7542
Practice Address - Country:US
Practice Address - Phone:352-796-5303
Practice Address - Fax:352-796-5304
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80781OtherBLUE CROSS BLUE SHIELD
FL253160700Medicaid
FLOS0006302OtherWORK COMP ID NUMBER
FLF54808Medicare UPIN
FL80781AMedicare ID - Type UnspecifiedPROVIDER NUMBER