Healthcare Provider Details

I. General information

NPI: 1932216389
Provider Name (Legal Business Name): PHILLIP R. BOWDEN, M.D.,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 MONROE AVE
MEMPHIS TN
38104-3634
US

IV. Provider business mailing address

1417 MONROE AVE
MEMPHIS TN
38104-3634
US

V. Phone/Fax

Practice location:
  • Phone: 901-272-7200
  • Fax: 901-260-5916
Mailing address:
  • Phone: 901-272-7200
  • Fax: 901-260-5916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SEANDRIA F EVANS
Title or Position: ADMINISTRATOR
Credential:
Phone: 901-272-7200