Healthcare Provider Details

I. General information

NPI: 1265928808
Provider Name (Legal Business Name): VICTOR MICHAEL BOWE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 EVERGREEN PL
HAMPTON VA
23666-2178
US

IV. Provider business mailing address

3 EVERGREEN PL
HAMPTON VA
23666-2178
US

V. Phone/Fax

Practice location:
  • Phone: 757-353-9772
  • Fax: 757-301-2239
Mailing address:
  • Phone: 757-353-9772
  • Fax: 757-301-2239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberT62119857
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: