Provider Demographics
NPI:1588863914
Name:BOWEN, GERALD THOMAS
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:THOMAS
Last Name:BOWEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E EADS PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:IN
Mailing Address - Zip Code:47025-7353
Mailing Address - Country:US
Mailing Address - Phone:812-539-2911
Mailing Address - Fax:812-537-7006
Practice Address - Street 1:555 E EADS PKWY STE 150
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:IN
Practice Address - Zip Code:47025-7353
Practice Address - Country:US
Practice Address - Phone:812-539-2911
Practice Address - Fax:812-537-7006
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01019985A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine