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NPI Code Detail

MEDICARE: DR. BRYAN LEE SOWELL M.D.

MEDICARE: DR. BRYAN LEE SOWELL 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
1207Q00000XFamily Medicine PhysicianA54025CA

Other Identifiers

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

General Provider Information

NPI Number : 1306896691
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRYAN LEE SOWELL M.D.
Provider Business Mailing Address
First Line : PO BOX 35380
Second Line :
City : LAS VEGAS
State : NV
Zip : 89133-5380
Country : US
Telephone Number : 702-579-3203
Fax Number :
Provider Business Practice Location Address
First Line : 1700 N WATERMAN AVE
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92404-5115
Country : US
Telephone Number : 909-883-8611
Fax Number : 909-881-5707
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 11/29/2025

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