1962409698 NPI number — DR. RICHARD G BOWLING DPM

Table of content: DR. RICHARD G BOWLING DPM (NPI 1962409698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962409698 NPI number — DR. RICHARD G BOWLING DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWLING
Provider First Name:
RICHARD
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962409698
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/21/2006
NPI Reactivation Date:
03/31/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3650 LAUREL AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAUMONT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-838-0346
Provider Business Mailing Address Fax Number:
409-839-3720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 JIMMY JOHNSON BLVD, #400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ARTHUR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-729-5633
Provider Business Practice Location Address Fax Number:
409-729-9760
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  1304 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5116373 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8778423210 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 9019276 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 018836901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00U60X . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 15486 . This is a "UTMB-CHIPS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 20300 . This is a "GTPA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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