Healthcare Provider Details

I. General information

NPI: 1841263589
Provider Name (Legal Business Name): JAMES T BOWLUS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E KIRACOFE AVE
ELIDA OH
45807-1034
US

IV. Provider business mailing address

PO BOX 3097
ELIDA OH
45807-0097
US

V. Phone/Fax

Practice location:
  • Phone: 419-331-0443
  • Fax: 419-331-3137
Mailing address:
  • Phone: 419-331-0443
  • Fax: 419-331-3137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35036062
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: