Healthcare Provider Details

I. General information

NPI: 1154379022
Provider Name (Legal Business Name): ELIZABETH J GOWER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CONSTITUTION DR SUITE 217
VIRGINIA BEACH VA
23462-6799
US

IV. Provider business mailing address

1300 LYNNWOOD DR
VIRGINIA BEACH VA
23452-6017
US

V. Phone/Fax

Practice location:
  • Phone: 757-499-7442
  • Fax: 757-490-3638
Mailing address:
  • Phone: 757-306-8940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101047362
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: