Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | DP00435 | OR |
NPI | 1093921975 |
---|---|
Provider Name | Dr. Brian M. Bowen |
First Address | Portland, OR 97213-1569 |
Second Address | Portland, OR 97213-1569 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 31/08/2012 |