Provider Demographics
NPI:1962513820
Name:BOWEN, JASON ROSS (DPM)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:ROSS
Last Name:BOWEN
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 1:3710 TWINBROOK ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-3714
Mailing Address - Country:US
Mailing Address - Phone:801-278-6603
Mailing Address - Fax:
Practice Address - Street 1:3710 TWINBROOK ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-3714
Practice Address - Country:US
Practice Address - Phone:801-278-6603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0616213ES0103X
CAE4715213ES0103X
NV0601213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV103476Medicare PIN
NVV11570Medicare UPIN