Healthcare Provider Details

I. General information

NPI: 1750130738
Provider Name (Legal Business Name): JOHN BOWERS JR. CEO DEJESUSBOWERS IN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14848 EDGEMERE DR FL USA
SPRING HILL FL
34609-0690
US

IV. Provider business mailing address

14848 EDGEMERE DR FL USA
SPRING HILL FL
34609-0690
US

V. Phone/Fax

Practice location:
  • Phone: 850-619-8454
  • Fax:
Mailing address:
  • Phone: 850-619-8454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberB620479563820
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: