Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | POR 207 | FL |
NPI | 1063740066 |
---|---|
Provider Name | Mitchell W Bowman |
First Address | Tallahassee, FL 32308-8405 |
Second Address | Tallahassee, FL 32308-8405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2009 |
Last Update Date | 02/12/2009 |