Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 116261 | NY |
NPI | 1003809492 |
---|---|
Provider Name | Dr. Robert Raymond Bowditch |
First Address | Elmira, NY 14901-3230 |
Second Address | Elmira, NY 14905-2220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 08/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00626962 | (05) | NY |
01039 | BCBS (01) | |
B81753 | (02) |