Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | ||
Y | 222Z00000X | Podiatrist | ||
N | 224P00000X | Prosthetist |
NPI | 1235326729 |
---|---|
Provider Name | Gerald David Bowman |
First Address | Reseda, CA 91335-6308 |
Second Address | Reseda, CA 91335-6308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2007 |
Last Update Date | 06/05/2009 |