Healthcare Provider Details

I. General information

NPI: 1922001890
Provider Name (Legal Business Name): THOMAS EDWARD BOWDEN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 MAIN ST
FRANKLINTON LA
70438-3688
US

IV. Provider business mailing address

321 WINDERMERE OAKS EAST
MADISONVILLE LA
70447
US

V. Phone/Fax

Practice location:
  • Phone: 985-795-5469
  • Fax:
Mailing address:
  • Phone: 985-845-0093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number09753R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: