Provider Demographics
NPI:1356401152
Name:WILLIAM J BOWMAN MD PC
Entity type:Organization
Organization Name:WILLIAM J BOWMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-788-1510
Mailing Address - Street 1:3601 S CLARKSON ST
Mailing Address - Street 2:SUITE 530
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3944
Mailing Address - Country:US
Mailing Address - Phone:303-788-1510
Mailing Address - Fax:303-788-1578
Practice Address - Street 1:3601 S CLARKSON ST
Practice Address - Street 2:SUITE 530
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3944
Practice Address - Country:US
Practice Address - Phone:303-788-1510
Practice Address - Fax:303-788-1578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21343207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO96823585Medicaid
CO807539Medicare ID - Type Unspecified