MEDICARE: DR C BRET BOWLING M D INDEPENDENT SPECIALIST OF FAMILY MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	105867	MO

General Provider Information

NPI Number	:	1518286707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR C BRET BOWLING M D INDEPENDENT SPECIALIST OF FAMILY MEDICINE

Provider Business Mailing Address
First Line	:	102 E CLEVELAND AVE
Second Line	:
City	:	MONETT
State	:	MO
Zip	:	65708-1405
Country	:	US
Telephone Number	:	417-235-0088
Fax Number	:	417-235-0101

Provider Business Practice Location Address
First Line	:	102 E CLEVELAND AVE
Second Line	:
City	:	MONETT
State	:	MO
Zip	:	65708-1405
Country	:	US
Telephone Number	:	417-235-0088
Fax Number	:	417-235-0101

Authorized Official
Title or Position	:	OWNER
Name	:	C BRET BOWLING
Credential	:	MD
Telephone Number	:	417-235-0088

Provider Enumeration Date	:	05/27/2010
Last Update Date	:	05/27/2010

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