Healthcare Provider Details

I. General information

NPI: 1043604176
Provider Name (Legal Business Name): KYLE THOMAS BOWERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MEDICAL PARK DR STE 140
TAMPA FL
33613-4679
US

IV. Provider business mailing address

3000 MEDICAL PARK DR STE 140
TAMPA FL
33613-4679
US

V. Phone/Fax

Practice location:
  • Phone: 813-978-8315
  • Fax:
Mailing address:
  • Phone: 813-978-8315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberME156113
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME156113
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: