Basic Information
Provider Information
NPI: 1265642524
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BOWMAN
FirstName: ERIN
MiddleName: MARIE
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 712 N WASHINGTON AVE
Address2: SUITE 101
City: DALLAS
State: TX
PostalCode: 752461619
CountryCode: US
TelephoneNumber: 2148268822
FaxNumber: 2148269792
Practice Location
Address1: 3500 GASTON AVE
Address2:  
City: DALLAS
State: TX
PostalCode: 752462017
CountryCode: US
TelephoneNumber: 2148268822
FaxNumber: 2148269792
Other Information
ProviderEnumerationDate: 05/23/2007
LastUpdateDate: 02/15/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202XN1561TXY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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