Healthcare Provider Details

I. General information

NPI: 1215217419
Provider Name (Legal Business Name): DAVID ZACHARY BOWMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 11/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

6041 CADILLAC AVE DEPARTMENT OF EMERGENCY MEDICINE
LOS ANGELES CA
90034-1702
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-2076
  • Fax: 314-747-8953
Mailing address:
  • Phone: 323-857-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA156709
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: