Healthcare Provider Details

I. General information

NPI: 1245274422
Provider Name (Legal Business Name): JENNIFER A. BOWE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 E 10TH ST
TRENTON MO
64683-9579
US

IV. Provider business mailing address

3300 E 10TH ST
TRENTON MO
64683-9579
US

V. Phone/Fax

Practice location:
  • Phone: 660-359-3939
  • Fax: 660-359-4372
Mailing address:
  • Phone: 660-359-3939
  • Fax: 660-359-4372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2002014049
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: