Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PY00002068 | FL |
N | 103TC0700X | Clinical Psychologist | PY00002068 | FL |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PY00002068 | FL |
N | 103G00000X | Clinical Psychologist | PY00002068 | FL |
N | 103TC0700X | Clinical Psychologist | PY00002068 | FL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PY00002068 | FL |
N | 103TF0200X | Forensic Psychologist | PY00002068 | FL |
NPI | 1437378890 |
---|---|
Provider Name | Dr. Ray Lee Bowman |
First Address | St Petersburg, FL 33710-8606 |
Second Address | St Petersburg, FL 33710-8606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 08/07/2007 |