Healthcare Provider Details

I. General information

NPI: 1073960704
Provider Name (Legal Business Name): BLAKE DAVID BOWDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 SPRING HILL AVE STE 3
MOBILE AL
36604-1410
US

IV. Provider business mailing address

1720 SPRING HILL AVE STE 3
MOBILE AL
36604-1410
US

V. Phone/Fax

Practice location:
  • Phone: 251-435-2663
  • Fax: 251-435-1098
Mailing address:
  • Phone: 251-435-2663
  • Fax: 251-435-1098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberMD.44106
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD.44106
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: