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NPI Code Detail

MEDICARE: MR. FREDERICK BLANCHARD BOWLES PA-C

MEDICARE: MR. FREDERICK BLANCHARD BOWLES PA-C
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
1363AM0700XMedical Physician Assistant314NV

General Provider Information

NPI Number : 1265435051
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. FREDERICK BLANCHARD BOWLES PA-C
Provider Business Mailing Address
First Line : PO BOX 1737
Second Line :
City : LAS VEGAS
State : NV
Zip : 89125-1737
Country : US
Telephone Number : 702-671-6845
Fax Number : 702-671-6883
Provider Business Practice Location Address
First Line : 4880 WYNN RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-5406
Country : US
Telephone Number : 702-871-5005
Fax Number : 702-873-9280
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 11/12/2007

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Directions to “ MR. FREDERICK BLANCHARD BOWLES PA-C” Practice Location

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