Provider Demographics
NPI:1215964473
Name:BOWERS, ANGELA G (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:G
Last Name:BOWERS
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 1:12700 PARK CENTRAL DR STE 1210
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-1522
Mailing Address - Country:US
Mailing Address - Phone:214-987-3376
Mailing Address - Fax:214-736-3763
Practice Address - Street 1:431 E STATE HIGHWAY 114 STE 300
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-1484
Practice Address - Country:US
Practice Address - Phone:817-251-6500
Practice Address - Fax:817-442-0550
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0476174400000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX345883AK4YOtherMEDICARE
TX8GJ204OtherBLUE CROSS BLUE SHIELD
TX0085GWOtherBLUE CROSS BLUE SHIELD