Provider Demographics
NPI:1770876682
Name:BOWMAN PETERSON, JILL M (MD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:M
Last Name:BOWMAN PETERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7244 YORK AVE S APT 317
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4491
Mailing Address - Country:US
Mailing Address - Phone:641-860-0191
Mailing Address - Fax:
Practice Address - Street 1:420 DELAWARE ST SE, MMC741
Practice Address - Street 2:UNIVERSITY OF MINNESOTA MEDICAL CENTER
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0356
Practice Address - Country:US
Practice Address - Phone:612-624-8984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN56818207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine