Individual
MR. BRYAN D BOWEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5212 W 7TH ST, WAKE VILLAGE, TX 75501-5930
(903) 831-6848
(903) 223-7089
Mailing address
2101 GALLERIA OAKS DR, TEXARKANA, TX 75503-4625
(903) 791-9120
(903) 791-9132
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
K1374
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113270606
—
TX
01
—
5011750001
CIGNA GOVERNMENT SERVICES
TX
Enumeration date
09/13/2005
Last updated
06/13/2014
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