Individual provider · NPI-1

Dr. Jason Ross Bowen, DPM

Podiatrist, Foot & Ankle Surgery · Salt Lake City, UT

NPI number1962513820
StatusActive
Last updated in NPPESNov 23, 2021

Details

NPI
1962513820
Entity type
Individual (NPI-1)
Name
Dr. Jason Ross Bowen
Credential
DPM
Sex
Male
Sole proprietor
Yes
Enumeration date
Aug 31, 2006
Certification date
Nov 23, 2021
Last updated
Nov 23, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
213ES0103X Podiatrist, Foot & Ankle Surgery0601NVYes
213ES0103X Podiatrist, Foot & Ankle Surgery0616AZ
213ES0103X Podiatrist, Foot & Ankle SurgeryE4715CA

Practice location

3710 Twinbrook St
Salt Lake City, UT 84109-3714

Phone 801-278-6603

Mailing address

3710 Twinbrook St
Salt Lake City, UT 84109-3714

Phone 801-278-6603

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