Provider Demographics
NPI:1962409698
Name:BOWLING, RICHARD G (DPM)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:BOWLING
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 1:3650 LAUREL AVENUE
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707
Mailing Address - Country:US
Mailing Address - Phone:409-838-0346
Mailing Address - Fax:409-839-3720
Practice Address - Street 1:2501 JIMMY JOHNSON BLVD, #400
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640
Practice Address - Country:US
Practice Address - Phone:409-729-5633
Practice Address - Fax:409-729-9760
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2015-02-03
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
TX1304213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5116373OtherAETNA
TX8778423210OtherUNITED HEALTHCARE
TX9019276OtherCIGNA
TX018836901Medicaid
TX00U60XOtherBCBS
UT15486OtherUTMB-CHIPS
TX20300OtherGTPA
TX20300OtherGTPA
TX00U60XMedicare UPIN
TX48002103233Medicare PIN