Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 2007008844 | MO |
Y | 213ES0000X | Sports Medicine | 2007008844 | MO |
NPI | 1073541827 |
---|---|
Provider Name | Dr. Jimmy Dayland Bowen |
First Address | Cape Girardeau, MO 63703-4928 |
Second Address | Cape Girardeau, MO 63703-4928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 26/10/2009 |