Healthcare Provider Details

I. General information

NPI: 1366540106
Provider Name (Legal Business Name): WILLIAM G. BOWLES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2673 DAVISSON RUN RD STE 101
CLARKSBURG WV
26301-6838
US

IV. Provider business mailing address

PO BOX 763
MORGANTOWN WV
26507-0763
US

V. Phone/Fax

Practice location:
  • Phone: 681-342-3470
  • Fax: 304-623-1602
Mailing address:
  • Phone: 800-541-4009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberWV01357
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: