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NPI Code Detail

MEDICARE: GARY BOWLING PA

MEDICARE:   GARY  BOWLING  PA
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
1363A00000XPhysician AssistantPA06704TX

General Provider Information

NPI Number : 1528368172
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY BOWLING PA
Provider Business Mailing Address
First Line : 175 UNION CHAPEL RD
Second Line :
City : CEDAR CREEK
State : TX
Zip : 78612-3111
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 175 UNION CHAPEL RD
Second Line :
City : CEDAR CREEK
State : TX
Zip : 78612-3111
Country : US
Telephone Number : 512-303-4821
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2010
Last Update Date : 10/29/2010

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Directions to “ GARY BOWLING PA” Practice Location

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