Provider Demographics
NPI:1831158385
Name:BOWDEN, JOHN BRADFORD (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BRADFORD
Last Name:BOWDEN
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 1:1651 GALISTEO ST STE 5
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505
Mailing Address - Country:US
Mailing Address - Phone:505-983-0286
Mailing Address - Fax:505-983-9203
Practice Address - Street 1:1651 GALISTEO ST STE 5
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-983-0286
Practice Address - Fax:505-983-9203
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6065207N00000X
NMMD2015-0592207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131854503Medicaid
TXL27JOtherBCBS
TX8AW453OtherBCBS
TXL27JOtherBCBS
TX8B6519Medicare UPIN