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General NPI Number Information
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NPI Number | 1073702130
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Entity Type | Individual
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Provider Name | JASON LYNN BOWERS PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 1723 BROADWAY ST SUITE 410
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63701-4505
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Country | US
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Telephone | 573-339-1957
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Fax | 573-339-9709
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Provider Business Mailing Address
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Address Line | 1723 BROADWAY ST STE 410
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63701-4556
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Country | US
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Telephone | 573-332-7746
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Fax | 573-339-9709
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2007031480
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License Number State | MO
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