Healthcare Provider Details

I. General information

NPI: 1558341453
Provider Name (Legal Business Name): BRIAN E BOWER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MEADOW POINTE
BARBOURSVILLE WV
25504-9209
US

IV. Provider business mailing address

104 MEADOW POINTE
BARBOURSVILLE WV
25504-9209
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-5405
  • Fax: 304-525-3400
Mailing address:
  • Phone: 304-525-5405
  • Fax: 304-525-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20870
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: