Provider Demographics
NPI:1386632354
Name:BOWLES, RICHARD K (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:K
Last Name:BOWLES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 15TH AVE SE STE C
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3797
Mailing Address - Country:US
Mailing Address - Phone:253-435-3400
Mailing Address - Fax:
Practice Address - Street 1:220 15TH AVE SE STE C
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3797
Practice Address - Country:US
Practice Address - Phone:253-435-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8140584Medicaid
WA8140584Medicaid
WAC90853Medicare UPIN