Provider Demographics
NPI:1902919665
Name:BOWHAY, THOMAS ALAN (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALAN
Last Name:BOWHAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 HIGHWAY 88
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-9547
Mailing Address - Country:US
Mailing Address - Phone:209-223-1720
Mailing Address - Fax:209-223-1477
Practice Address - Street 1:820 N HIGHWAY 49-88
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-9547
Practice Address - Country:US
Practice Address - Phone:209-223-1720
Practice Address - Fax:209-223-1477
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45383207P00000X, 207Q00000X
CA261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A453830Medicaid
CA00A453831Medicare PIN
C97716Medicare UPIN
CA00A453830Medicaid