Healthcare Provider Details

I. General information

NPI: 1174586374
Provider Name (Legal Business Name): RICHARD T BOWDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S MAIN ST STE B SOUTHEASTERN PSYCHIATRIC SERVICES
MCALESTER OK
74501-5370
US

IV. Provider business mailing address

PO BOX 1589 SOUTHEASTERN PSYCHIATRIC SERVICES
MCALESTER OK
74502-1589
US

V. Phone/Fax

Practice location:
  • Phone: 918-423-3700
  • Fax: 918-423-3712
Mailing address:
  • Phone: 918-423-3700
  • Fax: 918-423-3712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number18185
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: