Provider Demographics
NPI:1992780852
Name:BOWLIN, SCOTT EDWARD (DO)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:EDWARD
Last Name:BOWLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 CLARE RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-2811
Mailing Address - Country:US
Mailing Address - Phone:913-422-3861
Mailing Address - Fax:913-322-9126
Practice Address - Street 1:5440 CLARE RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66226-2811
Practice Address - Country:US
Practice Address - Phone:913-422-3861
Practice Address - Fax:913-322-9126
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5P18207QG0300X
KS22870207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO080069169OtherRAILRD MEDICARE-TRAVELERS
KS080069169OtherRLRD MEDICARE-TRAVELER'S
MO242097806Medicaid
MO0005301GMedicare PIN
MO080069169OtherRAILRD MEDICARE-TRAVELERS
KS0005301DMedicare ID - Type UnspecifiedMEDICARE PROVIDER#