Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 4905 | AL |
NPI | 1043298698 |
---|---|
Provider Name | Dr. Jon N Bowie |
First Address | Mobile, AL 36609-7873 |
Second Address | Mobile, AL 36609-7873 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2006 |
Last Update Date | 12/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009985270 | (05) | AL |