Provider Demographics
NPI:1174586374
Name:BOWDEN, RICHARD T (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:T
Last Name:BOWDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1589
Mailing Address - Street 2:SOUTHEASTERN PSYCHIATRIC SERVICES
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74502-1589
Mailing Address - Country:US
Mailing Address - Phone:918-423-3700
Mailing Address - Fax:918-423-3712
Practice Address - Street 1:100 S MAIN ST STE B
Practice Address - Street 2:SOUTHEASTERN PSYCHIATRIC SERVICES
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5370
Practice Address - Country:US
Practice Address - Phone:918-423-3700
Practice Address - Fax:918-423-3712
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK181852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100747990BMedicaid
OKF62979OtherSTERLING OPTION 1
OKF62979Medicare UPIN
OK100747990BMedicaid