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General NPI Number Information
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NPI Number | 1467130294
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Entity Type | Organization
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Legal Business Name | BOWER UROLOGY LLC
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Dates
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Enumeration Date | 07/11/2023
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 1941 SE PORT ST LUCIE BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-5535
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Country | US
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Telephone | 772-340-6777
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Fax | 772-236-3002
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Provider Business Mailing Address
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Address Line | 1941 SE PORT ST LUCIE BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-5535
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Country | US
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Telephone | 772-340-6777
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Fax | 772-236-3002
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Authorized Official
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Title or Position | CEO
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Name | PAMELA BOWER
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Credential |
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Telephone | 646-271-0212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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