Provider Demographics
NPI:1124060264
Name:BOWEN, GERARD JOHN JR (MHA, ATC)
Entity type:Individual
Prefix:MR
First Name:GERARD
Middle Name:JOHN
Last Name:BOWEN
Suffix:JR
Gender:M
Credentials:MHA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6034 BRAEBURN CT
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5746
Mailing Address - Country:US
Mailing Address - Phone:318-549-3421
Mailing Address - Fax:
Practice Address - Street 1:2571 HIGHWAY 171
Practice Address - Street 2:
Practice Address - City:STONEWALL
Practice Address - State:LA
Practice Address - Zip Code:71078-9423
Practice Address - Country:US
Practice Address - Phone:318-925-6917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer