Healthcare Provider Details

I. General information

NPI: 1598023236
Provider Name (Legal Business Name): GEORGE STEPHEN BOWEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 SW 6TH AVENUE
FORT LAUDERDALE FL
33315-2613
US

IV. Provider business mailing address

780 SW 24TH STREET
FORT LAUDERDALE FL
33315-2643
US

V. Phone/Fax

Practice location:
  • Phone: 954-467-4700
  • Fax: 954-467-4704
Mailing address:
  • Phone: 954-467-4700
  • Fax: 954-467-4704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberPHC21
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: