Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 50290251205 | UT |
NPI | 1114950714 |
---|---|
Provider Name | Dr. B Jason Bowles |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | St George, UT 84790-2123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 25/06/2008 |