Individual
GLEN BOWMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
350 W THOMAS RD, ATTN: BNI SURGICAL SUITE, PHOENIX, AZ 85013
(602) 406-3541
Mailing address
240 W THOMAS RD # 301, PHOENIX, AZ 85013-4407
(602) 406-6238
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
319122-1205
UT
207L00000X
Anesthesiology Physician
Primary
73631
AZ
207L00000X
Anesthesiology Physician
G185046
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100503208
—
NV
01
—
107028042101
IHC
UT
05
—
119647200
—
WY
01
—
1502954
UMWA
UT
01
—
2090168
UNITED HEALTHCARE
UT
01
—
77515
PEHP
UT
05
—
806868300
—
ID
01
—
835388
HEALTHY U
UT
01
—
851001
DESERET MUTUAL
UT
05
—
858409
—
AZ
01
—
870545614BOW
EDUCATORS MUTUAL
UT
01
—
QM0000075886
ALTIUS
UT
01
—
TPRA09326
MOLINA
UT
Enumeration date
08/31/2006
Last updated
07/19/2024
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