Healthcare Provider Details

I. General information

NPI: 1952373755
Provider Name (Legal Business Name): BRUCE BOWMAN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-9100
  • Fax: 860-545-9095
Mailing address:
  • Phone: 860-545-9100
  • Fax: 860-545-9095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000115
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: