Healthcare Provider Details

I. General information

NPI: 1053311068
Provider Name (Legal Business Name): VERNON DEAN BOWMAN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 HWY 32-2A
ASHDOWN AR
71822
US

IV. Provider business mailing address

146 HWY 32-2A
ASHDOWN AR
71822
US

V. Phone/Fax

Practice location:
  • Phone: 870-898-5525
  • Fax:
Mailing address:
  • Phone: 870-898-5525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM3478
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE3830
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: