Individual
LENNON E. BOWEN IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6300 E LAKE BLVD STE 201, VANCLEAVE, MS 39565
(228) 230-2663
(228) 206-1192
Mailing address
6300 E LAKE BLVD STE 301, VANCLEAVE, MS 39565-6771
(228) 230-2663
(228) 206-1192
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
18586
MS
2084N0600X
Clinical Neurophysiology Physician
18586
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02277207
—
MS
01
—
646000515
COMMERCIAL
—
01
—
P00280787
RAILROAD MEDICARE
—
Enumeration date
06/11/2006
Last updated
12/14/2018
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