Provider Demographics
NPI:1992766190
Name:BOWMAN-MARSH, JAN (MD)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:BOWMAN-MARSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 708850
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-8850
Mailing Address - Country:US
Mailing Address - Phone:866-869-2397
Mailing Address - Fax:801-352-9502
Practice Address - Street 1:3333 W DEYOUNG ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5884
Practice Address - Country:US
Practice Address - Phone:618-998-7492
Practice Address - Fax:618-998-7493
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036076429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036076429OtherBCBS
IL036076429Medicaid
ILP00172788OtherRAIL ROAD MEDICARE
ILK10424Medicare ID - Type Unspecified
IL036076429OtherBCBS