Healthcare Provider Details

I. General information

NPI: 1184846131
Provider Name (Legal Business Name): ADAM M BOWMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1548 E 4500 S STE 105
SALT LAKE CITY UT
84117-5209
US

IV. Provider business mailing address

1580 W ANTELOPE DR SUITE 175
LAYTON UT
84041-1160
US

V. Phone/Fax

Practice location:
  • Phone: 14-243-0908
  • Fax: 801-424-3091
Mailing address:
  • Phone: 801-773-2233
  • Fax: 801-773-2375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number65922181205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: