Healthcare Provider Details

I. General information

NPI: 1093929036
Provider Name (Legal Business Name): JON R BOWEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 AIRPORT RD
CHAPMANVILLE WV
25508-9202
US

IV. Provider business mailing address

PO BOX 4013
CHAPMANVILLE WV
25508-4013
US

V. Phone/Fax

Practice location:
  • Phone: 304-855-1200
  • Fax: 304-855-1230
Mailing address:
  • Phone: 304-855-1200
  • Fax: 304-855-1230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22652
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: