Provider Demographics
NPI:1982803862
Name:BOWLING, WILLIAM BRENT (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BRENT
Last Name:BOWLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-268-3735
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:101 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401
Practice Address - Country:US
Practice Address - Phone:601-268-3735
Practice Address - Fax:601-579-5240
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20264208000000X
MST-1783208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01182331Medicaid
MS9501164OtherAETNA
MS512I370089Medicare PIN