Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0127X | Trauma Surgeon | G72140 | CA |
Y | 2086S0129X | Vascular Surgeon | G72140 | CA |
NPI | 1164488946 |
---|---|
Provider Name | Dr. Jon C. Bowersox |
First Address | Chico, CA 95926-3310 |
Second Address | Chico, CA 95926-3310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 22/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2690655 | (05) | OH |
G16523 | (02) | OH |