MEDICARE: THOMAS BOWLUS 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	2084P0800X	Psychiatry Physician	G39810	CA

General Provider Information

NPI Number	:	1154492072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS BOWLUS MD

Provider Business Mailing Address
First Line	:	9890 COUNTY FARM RD STE 1
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-3678
Country	:	US
Telephone Number	:	951-358-6512
Fax Number	:

Provider Business Practice Location Address
First Line	:	9890 COUNTY FARM RD STE 1
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-3678
Country	:	US
Telephone Number	:	951-358-6512
Fax Number	:

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	04/14/2021

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