Provider Demographics
NPI:1730277518
Name:BOWMAN, WILLIAM KELLY (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:KELLY
Last Name:BOWMAN
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 1:3314 ROYAL ASCOT RUN
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-5116
Mailing Address - Country:US
Mailing Address - Phone:407-294-9806
Mailing Address - Fax:
Practice Address - Street 1:2700 OLD WINTER GARDEN RD
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2964
Practice Address - Country:US
Practice Address - Phone:407-253-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL71539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG86850Medicare UPIN