Provider Demographics
NPI:1366540106
Name:BOWLES, WILLIAM G (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:G
Last Name:BOWLES
Suffix:
Gender:M
Credentials:DO
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 763
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0763
Mailing Address - Country:US
Mailing Address - Phone:800-541-4009
Mailing Address - Fax:
Practice Address - Street 1:2673 DAVISSON RUN RD STE 101
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-6838
Practice Address - Country:US
Practice Address - Phone:681-342-3470
Practice Address - Fax:304-623-1602
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV01357207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0044356000Medicaid
F40264Medicare UPIN
BO0760601Medicare ID - Type Unspecified