Healthcare Provider Details

I. General information

NPI: 1710106893
Provider Name (Legal Business Name): STEVEN K BOWEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 OWEN DR
FAYETTEVILLE NC
28304-3425
US

IV. Provider business mailing address

1645 OWEN DR
FAYETTEVILLE NC
28304-3425
US

V. Phone/Fax

Practice location:
  • Phone: 910-486-4486
  • Fax: 910-486-0097
Mailing address:
  • Phone: 910-486-4486
  • Fax: 910-486-0097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN K BOWEN
Title or Position: DOCTOR
Credential: DPM
Phone: 910-486-4486