Healthcare Provider Details

I. General information

NPI: 1124769203
Provider Name (Legal Business Name): ANDREW BOWMAN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S UTICA AVE
TULSA OK
74104-4012
US

IV. Provider business mailing address

150 ENCLAVE CIR APT B6
CAPE GIRARDEAU MO
63701-2880
US

V. Phone/Fax

Practice location:
  • Phone: 918-592-0999
  • Fax:
Mailing address:
  • Phone: 901-849-7047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: