Basic Information
| Provider Information | |||||||||
| NPI: | 1326070665 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOWMAN | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 825 SE BISHOP BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | PULLMAN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 991635537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093322517 | ||||||||
| FaxNumber: | 5093349247 | ||||||||
| Practice Location | |||||||||
| Address1: | 3355 FOOTHILL RD | ||||||||
| Address2: | |||||||||
| City: | MOSCOW | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838438765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093322517 | ||||||||
| FaxNumber: | 5093349247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | MD00045278 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 807307400 | 05 | ID | MEDICAID | 8431546 | 05 | WA | MEDICAID |