Provider Demographics
NPI:1104894187
Name:BOWERS, RONALD ELROY JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:ELROY
Last Name:BOWERS
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:12042 ODION LN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5341
Mailing Address - Country:US
Mailing Address - Phone:703-583-7730
Mailing Address - Fax:703-805-0820
Practice Address - Street 1:9501 FARRELL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5901
Practice Address - Country:US
Practice Address - Phone:703-805-0096
Practice Address - Fax:703-805-0820
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110-840497363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical