Individual
REGINALD BOWMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
600 S 13TH ST, STE A, PEKIN, IL 61554-4936
(309) 347-2191
(309) 347-4821
Mailing address
600 S 13TH ST, STE A, PEKIN, IL 61554-4936
(309) 347-2191
(309) 347-4821
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036127588
IL
208000000X
Pediatrics Physician
R1562
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036127588
—
IL
Enumeration date
07/15/2008
Last updated
01/15/2013
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