Provider Demographics
NPI:1932216389
Name:PHILLIP R. BOWDEN, M.D.,P.A.
Entity Type:Organization
Organization Name:PHILLIP R. BOWDEN, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SEANDRIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-272-7200
Mailing Address - Street 1:1417 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3634
Mailing Address - Country:US
Mailing Address - Phone:901-272-7200
Mailing Address - Fax:901-260-5916
Practice Address - Street 1:1417 MONROE AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3634
Practice Address - Country:US
Practice Address - Phone:901-272-7200
Practice Address - Fax:901-260-5916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3709199Medicaid
TN3709199Medicaid