Healthcare Provider Details

I. General information

NPI: 1376520049
Provider Name (Legal Business Name): VAUGHAN RICHARD BOWEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4447 S CANYON RD STE 6
RAPID CITY SD
57702-1889
US

IV. Provider business mailing address

4447 S CANYON RD STE 6
RAPID CITY SD
57702-1889
US

V. Phone/Fax

Practice location:
  • Phone: 605-716-0548
  • Fax: 605-716-0447
Mailing address:
  • Phone: 605-716-0548
  • Fax: 605-716-0447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number20580
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2020030112
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number11214
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: