Provider Demographics
NPI:1841263589
Name:BOWLUS, JAMES T
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:BOWLUS
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:PO BOX 3097
Mailing Address - Street 2:
Mailing Address - City:ELIDA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-0097
Mailing Address - Country:US
Mailing Address - Phone:419-331-0443
Mailing Address - Fax:419-331-3137
Practice Address - Street 1:610 E KIRACOFE AVE
Practice Address - Street 2:
Practice Address - City:ELIDA
Practice Address - State:OH
Practice Address - Zip Code:45807-1034
Practice Address - Country:US
Practice Address - Phone:419-331-0443
Practice Address - Fax:419-331-3137
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000355251OtherANTHEM BC BS
OH0305146Medicaid
OH012675073OtherRAILROAD MEDICARE
OH341435892-00OtherWORKER'S COMPENSATION
OH0399354Medicare PIN
OH341435892-00OtherWORKER'S COMPENSATION