MEDICARE: CHARLES BRADLEY 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	207WX0120X	Cornea and External Diseases Specialist Physician	J6076	TX
2	207W00000X	Ophthalmology Physician	J6076	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8X1371	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457397762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES BRADLEY BOWMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 730486
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75373-0486
Country	:	US
Telephone Number	:	214-692-0146
Fax Number	:	214-692-1698

Provider Business Practice Location Address
First Line	:	10740 N CENTRAL EXPY
Second Line	:	SUITE 350
City	:	DALLAS
State	:	TX
Zip	:	75231-2161
Country	:	US
Telephone Number	:	214-692-0146
Fax Number	:	214-692-1698

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	08/24/2023

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Directions to “ CHARLES BRADLEY BOWMAN MD” Practice Location

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