Basic Information
| Provider Information | |||||||||
| NPI: | 1306886031 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOWLWARE | ||||||||
| FirstName: | KEN | ||||||||
| MiddleName: | |||||||||
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| Credential: | D. O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7100 S I 35 SERVICE RD | ||||||||
| Address2: | SUITE 7 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731492740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056321002 | ||||||||
| FaxNumber: | 4056323131 | ||||||||
| Practice Location | |||||||||
| Address1: | 7100 S I 35 SERVICE RD | ||||||||
| Address2: | SUITE 7 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731492740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056321002 | ||||||||
| FaxNumber: | 4056323131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 09/14/2012 | ||||||||
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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 | 207Q00000X | 3557 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.