Healthcare Provider Details

I. General information

NPI: 1962472019
Provider Name (Legal Business Name): STEPHEN MALCOLM BOWERS MD MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US HWY 160 & NAVAJO ROUTE 35 - RED MESA
TEECNOSPOS AZ
86514
US

IV. Provider business mailing address

PO BOX 160
SHIPROCK NM
87420-0160
US

V. Phone/Fax

Practice location:
  • Phone: 928-656-5000
  • Fax:
Mailing address:
  • Phone: 928-656-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number032229
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: