Healthcare Provider Details

I. General information

NPI: 1306409586
Provider Name (Legal Business Name): ANDREW DAVID BOWMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 07/15/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3234 MARYSVILLE BLVD
SACRAMENTO CA
95815-1411
US

IV. Provider business mailing address

1860 HOWE AVE STE 440
SACRAMENTO CA
95825-1098
US

V. Phone/Fax

Practice location:
  • Phone: 916-454-2345
  • Fax:
Mailing address:
  • Phone: 916-569-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA180444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: