Basic Information
| Provider Information | |||||||||
| NPI: | 1013076108 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOWMAN | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1390 S POTOMAC ST | ||||||||
| Address2: | SUITE 124 | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800126165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033688611 | ||||||||
| FaxNumber: | 3033689791 | ||||||||
| Practice Location | |||||||||
| Address1: | 3464 S WILLOW ST | ||||||||
| Address2: | SUITE 194 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802314531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037552900 | ||||||||
| FaxNumber: | 3037457997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 10/18/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 21343 | CO | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 840854490 | 01 | TAXID | OTHER | 205119406 | 01 | TAXID | OTHER | 01213438 | 05 | CO | MEDICAID |