Healthcare Provider Details

I. General information

NPI: 1003842089
Provider Name (Legal Business Name): ROBERT JOHN BOWERS II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 WESTLAKE DR 101
MORGANTOWN WV
26508-4470
US

IV. Provider business mailing address

3910 WESTLAKE DR
MORGANTOWN WV
26508-4470
US

V. Phone/Fax

Practice location:
  • Phone: 304-594-9209
  • Fax: 304-599-8917
Mailing address:
  • Phone: 304-594-9209
  • Fax: 304-599-8917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17450
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: