Provider Demographics
NPI:1538155338
Name:BOWLING, CHARLES BRET (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:BRET
Last Name:BOWLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:C
Other - Middle Name:BRET
Other - Last Name:BOWLING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:102 E CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:MONETT
Mailing Address - State:MO
Mailing Address - Zip Code:65708-1405
Mailing Address - Country:US
Mailing Address - Phone:417-235-0088
Mailing Address - Fax:417-235-0101
Practice Address - Street 1:102 E CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-1405
Practice Address - Country:US
Practice Address - Phone:417-235-0088
Practice Address - Fax:417-235-0101
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105867207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E10932Medicare UPIN
000094303Medicare ID - Type Unspecified