Healthcare Provider Details

I. General information

NPI: 1881662419
Provider Name (Legal Business Name): KAREN L BOWLWARE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N PHILLIPS AVE SUITE 6100
OKLAHOMA CITY OK
73104-4600
US

IV. Provider business mailing address

1122 NE 13TH ST ORI236
OKLAHOMA CITY OK
73117-1039
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-6827
  • Fax: 405-271-4418
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20829
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number20829
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: