Provider Demographics
NPI:1396752804
Name:BOWMAN, LYNTHIA BRADLEY (DO)
Entity type:Individual
Prefix:DR
First Name:LYNTHIA
Middle Name:BRADLEY
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LYNTHIA
Other - Middle Name:B
Other - Last Name:ANDREWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5325 FARAON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3488
Mailing Address - Country:US
Mailing Address - Phone:816-271-6122
Mailing Address - Fax:816-271-6019
Practice Address - Street 1:5325 FARAON ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3488
Practice Address - Country:US
Practice Address - Phone:816-271-6122
Practice Address - Fax:816-271-6019
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1B08207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100231970AMedicaid
MO241534338Medicaid
B464697BMedicare ID - Type Unspecified
KS100231970AMedicaid