Provider Demographics
NPI:1740530898
Name:BOWEN, WESLEY PAUL (PA)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:PAUL
Last Name:BOWEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:SHMG/HPE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-278-3000
Mailing Address - Fax:850-475-4781
Practice Address - Street 1:7800 US HIGHWAY 98 W
Practice Address - Street 2:ED
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-7228
Practice Address - Country:US
Practice Address - Phone:850-278-3000
Practice Address - Fax:850-475-4781
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2014-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9106736363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical