Basic Information
| Provider Information | |||||||||
| NPI: | 1336185362 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOWDISH | ||||||||
| FirstName: | GAIL | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 411 WALNUT ST | ||||||||
| Address2: | PMB 9138 | ||||||||
| City: | GREEN COVE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320433443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6164021505 | ||||||||
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| Practice Location | |||||||||
| Address1: | 502 E SECOND ST | ||||||||
| Address2: | ESSENTIA HEALTH | ||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187868364 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 03/25/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 073150 | MI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 35905 | MN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 23512 | NE | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 39266 | WI | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4150898 | 05 | MI | MEDICAID |