Healthcare Provider Details

I. General information

NPI: 1922458892
Provider Name (Legal Business Name): BRADLEY JOHN BOWLES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 W COUGAR BLVD STE 503
PROVO UT
84604-3323
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-374-9100
  • Fax: 801-374-9117
Mailing address:
  • Phone: 801-374-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number2022046851
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number62608
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number13253486-1235
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: