Healthcare Provider Details

I. General information

NPI: 1023718285
Provider Name (Legal Business Name): JONATHAN BOWERS SURGICAL ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 BREMO RD
RICHMOND VA
23226-1907
US

IV. Provider business mailing address

5801 BREMO RD
RICHMOND VA
23226-1907
US

V. Phone/Fax

Practice location:
  • Phone: 804-281-8503
  • Fax: 804-282-8248
Mailing address:
  • Phone: 804-281-8503
  • Fax: 804-282-8248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number0136000575
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: