Basic Information
| Provider Information | |||||||||
| NPI: | 1982657219 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOWLING | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 635283 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452635283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593445555 | ||||||||
| FaxNumber: | 8593445552 | ||||||||
| Practice Location | |||||||||
| Address1: | 135 COURTHOUSE CROSSING | ||||||||
| Address2: | |||||||||
| City: | INDEPENDENCE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410512509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593566800 | ||||||||
| FaxNumber: | 8593634073 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 11/20/2018 | ||||||||
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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 | 51805 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 115987 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.