MEDICARE: STEPHEN DOUGLAS BOWMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist	287	OH

General Provider Information

NPI Number	:	1033638275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN DOUGLAS BOWMAN

Provider Business Mailing Address
First Line	:	1115 FARLOW ST
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45503-4337
Country	:	US
Telephone Number	:	937-536-2764
Fax Number	:

Provider Business Practice Location Address
First Line	:	1115 FARLOW ST
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45503-4337
Country	:	US
Telephone Number	:	937-536-2764
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2017
Last Update Date	:	06/21/2026

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