Healthcare Provider Details

I. General information

NPI: 1619665510
Provider Name (Legal Business Name): BENJAMIN BOWER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 SKYLINE DR
RUSSELLVILLE AR
72801-3362
US

IV. Provider business mailing address

PO BOX 9662
CONWAY AR
72033-9662
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-7170
  • Fax: 479-968-7607
Mailing address:
  • Phone: 501-852-1363
  • Fax: 501-852-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE19879
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: