=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972701951
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIRK WILLIAM BOWMAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2007
-----------------------------------------------------
Last Update Date | 12/15/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 829 N CENTER AVE STE 120
-----------------------------------------------------
City | GAYLORD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49735-1598
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-731-7987
-----------------------------------------------------
Fax | 989-731-7983
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 418 ROBERTS AVE APT 1
-----------------------------------------------------
City | GAYLORD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49735-8391
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-703-3834
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 57-011884
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------