Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 99143 | MT |
NPI | 1164819199 |
---|---|
Provider Name | Joshua Sean Bowler |
First Address | Dallas, TX 75246-2017 |
Second Address | Billings, MT 59101-7507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2015 |
Last Update Date | 02/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
99143 | LICENSE (01) | MT |
FB0374431 | DEA (01) | MT |