Healthcare Provider Details

I. General information

NPI: 1477809382
Provider Name (Legal Business Name): JOHN ANTHONEY BOWN JR. R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2012
Last Update Date: 07/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 LA JOLLA VILLAGE DR
SAN DIEGO CA
92161-0002
US

IV. Provider business mailing address

PO BOX 16434
FT WORTH TX
76162-0434
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-8585
  • Fax:
Mailing address:
  • Phone: 214-883-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number763657
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: