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NPI Code Detail

MEDICARE: JAN BOWMAN-MARSH MD

MEDICARE:   JAN  BOWMAN-MARSH  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
1207Q00000XFamily Medicine Physician036076429IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00172788OTHERILRAIL ROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1036076429OTHERILBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1992766190
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAN BOWMAN-MARSH MD
Provider Business Mailing Address
First Line : PO BOX 708850
Second Line :
City : SANDY
State : UT
Zip : 84070-8850
Country : US
Telephone Number : 866-869-2397
Fax Number : 801-352-9502
Provider Business Practice Location Address
First Line : 3333 W DEYOUNG ST
Second Line :
City : MARION
State : IL
Zip : 62959-5884
Country : US
Telephone Number : 618-998-7492
Fax Number : 618-998-7493
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2006
Last Update Date : 05/28/2008

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Directions to “ JAN BOWMAN-MARSH MD” Practice Location

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