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General NPI Number Information
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NPI Number | 1902020241
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Entity Type | Organization
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Legal Business Name | CECIL D BOWEN JR, MD A PROFRSSIONAL CORPORATION
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 01/05/2010
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Provider Practice Location Address
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Address Line | 250 N 1ST ST
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City | BLYTHE
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State | CA
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Zip | 92225-1702
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Country | US
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Telephone | 760-921-5202
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Fax | 760-921-8674
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Provider Business Mailing Address
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Address Line | PO BOX 1175
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City | BLYTHE
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State | CA
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Zip | 92226-1175
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Country | US
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Telephone | 760-861-0432
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Fax | 760-921-8674
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | CECIL D BOWEN JR.
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Credential | MD
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Telephone | 760-861-0432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G66633
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License Number State | CA
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