Healthcare Provider Details

I. General information

NPI: 1720093495
Provider Name (Legal Business Name): BRADLEY BLAKE BOWER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5304 CANE RIDGE RD
ANTIOCH TN
37013-3839
US

IV. Provider business mailing address

909 CLARION DR
GILLETTE WY
82718-3901
US

V. Phone/Fax

Practice location:
  • Phone: 615-846-4545
  • Fax:
Mailing address:
  • Phone: 858-395-6937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number77190
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number77190
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: