MEDICARE: DR. MICHAEL T. BOWERSOX M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G53320	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285652818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL T. BOWERSOX M.D.

Provider Business Mailing Address
First Line	:	16613 WIKIUP RD
Second Line	:
City	:	RAMONA
State	:	CA
Zip	:	92065-4161
Country	:	US
Telephone Number	:	858-243-2851
Fax Number	:	760-748-6800

Provider Business Practice Location Address
First Line	:	15025 INNOVATION DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-3409
Country	:	US
Telephone Number	:	858-605-7166
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	09/08/2019

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