Healthcare Provider Details

I. General information

NPI: 1699724807
Provider Name (Legal Business Name): ROGER HARRISON BOWER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 NATIONAL HEALTH CARE DR
DAYTONA BEACH FL
32114-1495
US

IV. Provider business mailing address

551 NATIONAL HEALTH CARE DR
DAYTONA BEACH FL
32114-1495
US

V. Phone/Fax

Practice location:
  • Phone: 386-323-7541
  • Fax: 386-323-7570
Mailing address:
  • Phone: 386-323-7541
  • Fax: 386-323-7570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME 81229
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: