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General NPI Number Information
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NPI Number | 1316101892
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Entity Type | Individual
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Provider Name | REGINALD BOWMAN
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Gender | Male
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Dates
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Enumeration Date | 07/15/2008
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Last Update Date | 01/15/2013
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Provider Practice Location Address
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Address Line | 600 S 13TH ST STE A
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City | PEKIN
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State | IL
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Zip | 61554-4936
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Country | US
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Telephone | 309-347-2191
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Fax | 309-347-4821
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Provider Business Mailing Address
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Address Line | 600 S 13TH ST STE A
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City | PEKIN
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State | IL
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Zip | 61554-4936
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Country | US
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Telephone | 309-347-2191
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Fax | 309-347-4821
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | R1562
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036127588
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License Number State | IL
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