Individual
DR. JOHN ALLEN BOVENMYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3319 SPRING ST, SUITE 102, DAVENPORT, IA 52807-2125
(563) 359-1671
(563) 359-7813
Mailing address
4660 CROW CREEK CT, BETTENDORF, IA 52722-2037
(563) 332-9878
(563) 359-7813
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
24892
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28028
WELLMART BC-BS
IA
01
—
A002022
TRICARE
—
Enumeration date
12/04/2006
Last updated
01/18/2008
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