Healthcare Provider Details

I. General information

NPI: 1316353949
Provider Name (Legal Business Name): MARK BOWERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 HEALTH CENTER DR
SAN DIEGO CA
92123-2762
US

IV. Provider business mailing address

2929 HEALTH CENTER DR
SAN DIEGO CA
92123-2762
US

V. Phone/Fax

Practice location:
  • Phone: 858-939-6505
  • Fax: 858-521-2340
Mailing address:
  • Phone: 858-939-6505
  • Fax: 858-521-2340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number62501
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberA168934
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number59334
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: