Healthcare Provider Details

I. General information

NPI: 1477555043
Provider Name (Legal Business Name): J RUSSELL BOWMAN DO, MS, MHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 SCARBOROUGH DR STE 100
COLORADO SPRINGS CO
80920-7518
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 719-364-6970
  • Fax: 719-365-7667
Mailing address:
  • Phone: 970-624-1103
  • Fax: 720-718-0994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4928
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0061591
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: