MEDICARE: DR. KENNY LANE BOWMAN D.O.

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	207P00000X	Emergency Medicine Physician	03047	KY
2	207Q00000X	Family Medicine Physician	03047	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740471960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNY LANE BOWMAN D.O.

Provider Business Mailing Address
First Line	:	253 CEDAR HILLS DR
Second Line	:
City	:	PIKEVILLE
State	:	KY
Zip	:	41501-8700
Country	:	US
Telephone Number	:	606-432-2213
Fax Number	:

Provider Business Practice Location Address
First Line	:	2710 N STEMMONS FWY (MAXIM PHYSICIAN RESOURCES)
Second Line	:	SUITE 100, NORTH TOWER
City	:	DALLAS
State	:	TX
Zip	:	75207-2210
Country	:	US
Telephone Number	:	888-800-1853
Fax Number	:	214-741-0701

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

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	01/28/2022

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Directions to “ DR. KENNY LANE BOWMAN D.O.” Practice Location

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