Individual
JEREMY S BOWEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
12860 TROXLER AVE, HIGHLAND, IL 62249-2898
(618) 651-2810
(618) 651-0077
Mailing address
12860 TROXLER AVE, HIGHLAND, IL 62249-2898
(618) 651-2810
(618) 651-0077
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
207988
MEDICARE GROUP NUMBER
IL
01
—
CK7203
RR GROUP NUMBER
IL
01
—
P00365761
RR MEDICARE NUMBER
IL
01
—
P019009721
BLUE CHOICE
NY
01
—
PA0495
PREFERRED CARE
NY
Enumeration date
08/31/2006
Last updated
12/18/2023
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