Healthcare Provider Details

I. General information

NPI: 1366435356
Provider Name (Legal Business Name): PHILLIP JEFFREY BOWER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 MEDICAL PARK DR SUITE 207
WALTERBORO SC
29488-5747
US

IV. Provider business mailing address

302 MEDICAL PARK DR SUITE 207
WALTERBORO SC
29488-5747
US

V. Phone/Fax

Practice location:
  • Phone: 843-782-2788
  • Fax: 843-782-2797
Mailing address:
  • Phone: 843-782-2788
  • Fax: 843-782-2797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number22458
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: