Healthcare Provider Details

I. General information

NPI: 1063801660
Provider Name (Legal Business Name): JOHN CLAY BOWEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 S ELM PL STE 120
BROKEN ARROW OK
74012-7816
US

IV. Provider business mailing address

6600 S YALE AVE STE 1200
TULSA OK
74136-3361
US

V. Phone/Fax

Practice location:
  • Phone: 918-451-5191
  • Fax: 918-449-4653
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5863
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: