Healthcare Provider Details

I. General information

NPI: 1538253083
Provider Name (Legal Business Name): SHERRY LYNN BOWERS D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 01/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 W MAGNOLIA AVE SUITE B
FORT WORTH TX
76104-4351
US

IV. Provider business mailing address

1305 W MAGNOLIA AVE SUITE B
FORT WORTH TX
76104-4351
US

V. Phone/Fax

Practice location:
  • Phone: 817-522-1530
  • Fax: 817-523-8667
Mailing address:
  • Phone: 817-522-1530
  • Fax: 817-523-8667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1387
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: