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Individual
DR. DALLIS MARK BOWDITCH
Active
Individual
DR. DALLIS MARK BOWDITCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01032465A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000546802
ANTHEM BLUE CROSS
—
01
—
080096741
MEDICARE RAILROAD
—
05
—
100070810
—
IN
01
—
112810C
OLD MEDICARE ID #
—
01
—
4216390
AETNA ID
IN
01
—
6148784003
CIGNA ID
IN
Enumeration date
05/27/2005
Last updated
12/01/2015
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