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NPI Code Detail

MEDICARE: DR. RONDA BOUWENS M.D.

MEDICARE: DR. RONDA BOUWENS M.D.
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
1207Q00000XFamily Medicine Physician61062895WA
2207Q00000XFamily Medicine Physician59964AZ
3207Q00000XFamily Medicine Physician42021-20WI

General Provider Information

NPI Number : 1104805134
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RONDA BOUWENS M.D.
Provider Business Mailing Address
First Line : 939 CAROLINE ST
Second Line :
City : PORT ANGELES
State : WA
Zip : 98362-3909
Country : US
Telephone Number : 360-417-7000
Fax Number :
Provider Business Practice Location Address
First Line : 939 CAROLINE ST
Second Line :
City : PORT ANGELES
State : WA
Zip : 98362-3909
Country : US
Telephone Number : 360-471-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2006
Last Update Date : 06/05/2020

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