Provider Demographics
NPI:1669615753
Name:BOWEN, FREDERICK EUGENE SR
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:EUGENE
Last Name:BOWEN
Suffix:SR
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 1:1907 CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1745
Mailing Address - Country:US
Mailing Address - Phone:651-603-3914
Mailing Address - Fax:651-645-1166
Practice Address - Street 1:1907 CHARLES AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-1745
Practice Address - Country:US
Practice Address - Phone:651-603-3914
Practice Address - Fax:651-645-1166
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)