Basic Information
Provider Information
NPI: 1386651859
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BOWEN
FirstName: ROBERT
MiddleName: L
NamePrefix: MR.
NameSuffix: II
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8800 SE SUNNYSIDE RD STE 300N
Address2:  
City: CLACKAMAS
State: OR
PostalCode: 970155703
CountryCode: US
TelephoneNumber: 2812862999
FaxNumber: 5126074893
Practice Location
Address1: 2685 PELHAM PKWY STE A
Address2:  
City: PELHAM
State: AL
PostalCode: 351241354
CountryCode: US
TelephoneNumber: 2056206047
FaxNumber: 2056201513
Other Information
ProviderEnumerationDate: 08/01/2006
LastUpdateDate: 03/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
237700000X2129ALY Speech, Language and Hearing Service ProvidersHearing Instrument Specialist 

No ID Information.


Home