Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 0160002172 | VT |
NPI | 1114931524 |
---|---|
Provider Name | Dr. Scott Martin Bowen |
First Address | Middlebury, VT 05753 |
Second Address | Middlebury, VT 05753 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 21/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1010129 | (05) | VT |
364864 | MVP (01) | VT |
59739 | BCBS (01) | VT |
H96520 | (02) |