Provider Demographics
NPI:1679709760
Name:BOWMAN, TIMOTHY R
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:R
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MOUNTAIN CT
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-5023
Mailing Address - Country:US
Mailing Address - Phone:307-514-0787
Mailing Address - Fax:307-514-0787
Practice Address - Street 1:112 MOUNTAIN CT
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-5023
Practice Address - Country:US
Practice Address - Phone:307-514-0787
Practice Address - Fax:307-514-0787
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator