Healthcare Provider Details

I. General information

NPI: 1629071402
Provider Name (Legal Business Name): PATRICIA JEAN BOWLING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 E 750 N
OREM UT
84097-4345
US

IV. Provider business mailing address

1350 E 750 N
OREM UT
84097-4345
US

V. Phone/Fax

Practice location:
  • Phone: 801-852-2273
  • Fax: 801-227-2199
Mailing address:
  • Phone: 801-852-2273
  • Fax: 801-227-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number5125
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number172239-1205
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier002018934
Identifier TypeMEDICAID
Identifier StateNV
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: