Healthcare Provider Details

I. General information

NPI: 1083650402
Provider Name (Legal Business Name): J.A. BOWE, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/20/2008
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 TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number2002014049
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER A. BOWE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 660-359-3939