Provider Demographics
NPI:1902807191
Name:BOWLING, ROBERT LEE (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:BOWLING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8711 VILLAGE DR STE 114
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5419
Mailing Address - Country:US
Mailing Address - Phone:210-297-2244
Mailing Address - Fax:210-297-2257
Practice Address - Street 1:19787 W IH 10 STE 104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257
Practice Address - Country:US
Practice Address - Phone:210-469-9775
Practice Address - Fax:210-469-9776
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXHO199207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115733106Medicaid
TX489911YMJMMedicare PIN