# DR. DALLIS MARK BOWDITCH

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1790788255
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 01032465A | IN | Yes |

## Other

- **Enumeration date:** 05/27/2005
- **Last updated:** 12/01/2015

## 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 |