MEDICARE: JANE C BOWMAN MD

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	207V00000X	Obstetrics & Gynecology Physician	1860261205	UT

General Provider Information

NPI Number	:	1073621611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE C BOWMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:	801-233-4400
Fax Number	:	801-233-4410

Provider Business Practice Location Address
First Line	:	3723 W 12600 S
Second Line	:	SUITE 360
City	:	RIVERTON
State	:	UT
Zip	:	84065-7295
Country	:	US
Telephone Number	:	801-285-4700
Fax Number	:	801-285-4601

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	02/29/2012

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