Healthcare Provider Details

I. General information

NPI: 1831195866
Provider Name (Legal Business Name): RICHARD P BOWLES JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 KENTUCKY
WEST PLAINS MO
65775
US

IV. Provider business mailing address

805 KENTUCKY AVE
WEST PLAINS MO
65775
US

V. Phone/Fax

Practice location:
  • Phone: 417-256-2111
  • Fax: 417-256-4858
Mailing address:
  • Phone: 417-256-2111
  • Fax: 417-256-4858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR8E37
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: