Healthcare Provider Details

I. General information

NPI: 1962409698
Provider Name (Legal Business Name): RICHARD G BOWLING DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date: 03/21/2006
Reactivation Date: 03/31/2006

III. Provider practice location address

2501 JIMMY JOHNSON BLVD, #400
PORT ARTHUR TX
77640
US

IV. Provider business mailing address

3650 LAUREL AVENUE
BEAUMONT TX
77707
US

V. Phone/Fax

Practice location:
  • Phone: 409-729-5633
  • Fax: 409-729-9760
Mailing address:
  • Phone: 409-838-0346
  • Fax: 409-839-3720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1304
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: