Derrick Bowling Md Pa | |
3516 Ne 12th Ave Oakland Park FL 33334-4524 | |
(954) 459-5487 | |
Not Available |
Full Name | Derrick Bowling Md Pa |
---|---|
Speciality | Clinic/Center |
Location | 3516 Ne 12th Ave, Oakland Park, Florida |
Authorized Official Name and Position | Derrick Bowling (MD/OWNER) |
Authorized Official Contact | 2053888863 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Derrick Bowling Md Pa 308 Ne 22nd St Wilton Manors FL 33305-1115 Ph: (205) 388-8863 | Derrick Bowling Md Pa 3516 Ne 12th Ave Oakland Park FL 33334-4524 Ph: (954) 459-5487 |
NPI Number | 1770118655 |
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Provider Enumeration Date | 03/11/2020 |
Last Update Date | 03/11/2020 |
Medicare PECOS PAC ID | 7911336375 |
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Medicare Enrollment ID | O20200406001789 |
Identifier | Type | State | Issuer |
---|---|---|---|
1770118655 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Derrick Bowling |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1184626277 PECOS PAC ID: 2264474188 Enrollment ID: I20170929000122 |
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