Healthcare Provider Details

I. General information

NPI: 1174710982
Provider Name (Legal Business Name): CAROL PATRICIA ROBERTINE BOWEN-WELLS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SHIRCLIFF WAY SUITE 630
JACKSONVILLE FL
32204-4776
US

IV. Provider business mailing address

3 SHIRCLIFF WAY SUITE 630
JACKSONVILLE FL
32204-4776
US

V. Phone/Fax

Practice location:
  • Phone: 904-281-5878
  • Fax: 904-645-5856
Mailing address:
  • Phone: 904-281-5878
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number41473
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number41473
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberME104932
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: