Provider Demographics
NPI:1952765174
Name:BOWLING, MARIALISON (MD)
Entity Type:Individual
Prefix:
First Name:MARIALISON
Middle Name:
Last Name:BOWLING
Suffix:
Gender:F
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:PO BOX 56649
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72215-6649
Mailing Address - Country:US
Mailing Address - Phone:501-224-1690
Mailing Address - Fax:
Practice Address - Street 1:4 EXECUTIVE CENTER CT
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4487
Practice Address - Country:US
Practice Address - Phone:501-448-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-127002084P0800X
TXBP10056556261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health