Healthcare Provider Details

I. General information

NPI: 1770767923
Provider Name (Legal Business Name): MATTHEW STILES BOWDISH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MATTHEW STILES MCDONALD M.D.

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 EUREKA RD STE 102
ROSEVILLE CA
95661-3047
US

IV. Provider business mailing address

1111 EXPOSITION BLVD BLDG 700
SACRAMENTO CA
95815-4314
US

V. Phone/Fax

Practice location:
  • Phone: 916-736-6644
  • Fax: 916-774-0143
Mailing address:
  • Phone: 916-736-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number044700
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA92192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: