Healthcare Provider Details

I. General information

NPI: 1316966724
Provider Name (Legal Business Name): RONNIE DURRELL BOWEN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3699 RIVERDALE RD
MEMPHIS TN
38115-5322
US

IV. Provider business mailing address

7296 ROURKE CIR
MEMPHIS TN
38125-4823
US

V. Phone/Fax

Practice location:
  • Phone: 190-136-5962
  • Fax:
Mailing address:
  • Phone: 901-756-1248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number38708
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38708
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: