Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 5863 | OK |
N | 207Q00000X | Family Doctor | 5863 | OK |
NPI | 1063801660 |
---|---|
Provider Name | John Clay Bowen |
First Address | Tulsa, OK 74104-5346 |
Second Address | Tulsa, OK 74104-5346 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2015 |
Last Update Date | 18/02/2020 |