Healthcare Provider Details

I. General information

NPI: 1497956403
Provider Name (Legal Business Name): CHARLES RODNEY BOWIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 PARK ROWE AVE STE. 200
BATON ROUGE LA
70810-1686
US

IV. Provider business mailing address

PO BOX 98509
BATON ROUGE LA
70884-9509
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-2200
  • Fax: 225-768-2185
Mailing address:
  • Phone: 225-769-2200
  • Fax: 225-768-2185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN9839
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number206668
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: