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General NPI Number Information
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NPI Number | 1750321733
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Entity Type | Individual
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Provider Name | GARY L. BOWMAN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 714 WASHINGTON AVE
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City | DETROIT LAKES
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State | MN
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Zip | 56501-3012
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Country | US
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Telephone | 218-847-1676
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Fax | 218-847-1678
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Provider Business Mailing Address
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Address Line | PO BOX 267
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City | ORR
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State | MN
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Zip | 55771-0267
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Country | US
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Telephone | 218-847-1676
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Fax | 218-847-1678
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP3287
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License Number State | MN
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