Provider Demographics
NPI:1912328659
Name:BOWMAN, DESHAUN
Entity Type:Individual
Prefix:
First Name:DESHAUN
Middle Name:
Last Name:BOWMAN
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 1:1330 N CLASSEN BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-6835
Mailing Address - Country:US
Mailing Address - Phone:405-606-4441
Mailing Address - Fax:
Practice Address - Street 1:1330 N CLASSEN BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6835
Practice Address - Country:US
Practice Address - Phone:405-606-4441
Practice Address - Fax:405-225-7326
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-24
Last Update Date:2013-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator