Provider Demographics
NPI:1194798892
Name:BOWER, MARY F (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:BOWER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-609-1112
Mailing Address - Fax:419-609-1123
Practice Address - Street 1:1479 N RIVER RD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-9760
Practice Address - Country:US
Practice Address - Phone:419-355-9440
Practice Address - Fax:419-355-9443
Is Sole Proprietor?:No
Enumeration Date:2006-02-12
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073482B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH56-2384971OtherCOMMERCIAL CLAIMS TAX ID
OH000000301960OtherANTHEM
OH2134532Medicaid
OHB73482OtherSUMMACARE
OH000000301960OtherANTHEM
OHP00122108Medicare ID - Type UnspecifiedRAILROAD
OH56-2384971OtherCOMMERCIAL CLAIMS TAX ID
OHB73482OtherSUMMACARE