Provider Demographics
NPI:1770906505
Name:BOWIE, LELAND
Entity type:Individual
Prefix:
First Name:LELAND
Middle Name:
Last Name:BOWIE
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 1:2401 NW 39TH STREET
Mailing Address - Street 2:STE 103
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-0000
Mailing Address - Country:US
Mailing Address - Phone:405-588-7641
Mailing Address - Fax:405-601-9668
Practice Address - Street 1:2401 NW 39TH STREET
Practice Address - Street 2:STE 103
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-0000
Practice Address - Country:US
Practice Address - Phone:405-588-7641
Practice Address - Fax:405-601-9668
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK303756171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator