Healthcare Provider Details

I. General information

NPI: 1619047362
Provider Name (Legal Business Name): JONATHAN CRAIG BOWMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 N MAIN ST
KANAB UT
84741-3260
US

IV. Provider business mailing address

1055 N 500 W ATTN: CREDENTIALING
PROVO UT
84604-3305
US

V. Phone/Fax

Practice location:
  • Phone: 435-644-4100
  • Fax: 435-644-3366
Mailing address:
  • Phone: 801-354-8225
  • Fax: 801-418-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5349812
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: