Provider Demographics
NPI:1083234975
Name:BOWERBANK, LANDON RYAN (DPM)
Entity type:Individual
Prefix:
First Name:LANDON
Middle Name:RYAN
Last Name:BOWERBANK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 N RUNNING CREEK WAY BLDG C SUITE 300
Mailing Address - Street 2:BLDG C SUITE 300
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-3654
Mailing Address - Country:US
Mailing Address - Phone:801-901-4333
Mailing Address - Fax:801-901-4268
Practice Address - Street 1:3300 N RUNNING CREEK WAY BLDG C SUITE 300
Practice Address - Street 2:BLDG C SUITE 300
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043
Practice Address - Country:US
Practice Address - Phone:801-901-4333
Practice Address - Fax:801-901-4268
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13221936-0501213E00000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery