Healthcare Provider Details

I. General information

NPI: 1588934939
Provider Name (Legal Business Name): WATSON ALLEN BOWES III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 LONG RIFLE RD
PARK CITY UT
84098-5641
US

IV. Provider business mailing address

7905 LONG RIFLE RD
PARK CITY UT
84098-5641
US

V. Phone/Fax

Practice location:
  • Phone: 801-442-5692
  • Fax:
Mailing address:
  • Phone: 801-442-5692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number182047-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: