Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036-050992 | IL |
NPI | 1003864489 |
---|---|
Provider Name | Robert L Bowser |
First Address | Evanston, IL 60202-3205 |
Second Address | Chicago, IL 60657-5081 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 06/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D14142 | (02) | IL |