Provider Demographics
NPI:1912996638
Name:BOWEN, PENNY LEE (MD)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:LEE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:LEE
Other - Last Name:KRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1201 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE 14000
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-2008
Mailing Address - Country:US
Mailing Address - Phone:480-545-8119
Mailing Address - Fax:480-892-6805
Practice Address - Street 1:1201 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE 14000
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-2008
Practice Address - Country:US
Practice Address - Phone:480-545-8119
Practice Address - Fax:480-892-6805
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ337492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ944761Medicaid
AZ944761Medicaid
AZZ164959Medicare PIN
AZZ128779Medicare PIN
AZZ133448Medicare PIN
AZZ128779Medicare PIN
AZZ133448Medicare PIN