Individual
DR. SHANE BOWEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3200 MACCORKLE AVE SE, CHARLESTON, WV 25304-1227
(304) 388-4170
Mailing address
501 MORRIS ST, CHARLESTON, WV 25301-1326
(800) 875-0136
(937) 619-4381
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
18065
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001718054
BLUE CROSS BLUE SHIELD
WV
05
—
0126718000
—
WV
01
—
1036688
CH WV DWC
WV
05
—
2333157
—
OH
01
—
3001167
WORKERS COMPENSATION
WV
05
—
64051394
—
KY
Enumeration date
01/03/2006
Last updated
07/11/2023
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