Provider Demographics
NPI:1831195866
Name:BOWLES, RICHARD P JR (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:P
Last Name:BOWLES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775
Mailing Address - Country:US
Mailing Address - Phone:417-256-2111
Mailing Address - Fax:417-256-4858
Practice Address - Street 1:805 KENTUCKY
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775
Practice Address - Country:US
Practice Address - Phone:417-256-2111
Practice Address - Fax:417-256-4858
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8E37207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO599002307Medicaid
MO599022308Medicaid
MO620492108Medicaid
080026433OtherMEDICARE RR
MOF28982Medicare UPIN
MO202118907Medicare ID - Type Unspecified
MO268904Medicare ID - Type UnspecifiedCARE RHC
MO000014537Medicare ID - Type UnspecifiedCARE PROFESSIONAL