Healthcare Provider Details

I. General information

NPI: 1831158385
Provider Name (Legal Business Name): JOHN BRADFORD BOWDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 GALISTEO ST STE 5
SANTA FE NM
87505
US

IV. Provider business mailing address

1651 GALISTEO ST STE 5
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-0286
  • Fax: 505-983-9203
Mailing address:
  • Phone: 505-983-0286
  • Fax: 505-983-9203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberH6065
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD2015-0592
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: