Provider Demographics
NPI:1275532251
Name:BOWERS, JAMELLE R (MD)
Entity type:Individual
Prefix:DR
First Name:JAMELLE
Middle Name:R
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 1:8000 5 MILE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-2187
Mailing Address - Country:US
Mailing Address - Phone:513-233-6980
Mailing Address - Fax:513-233-6983
Practice Address - Street 1:8000 5 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2187
Practice Address - Country:US
Practice Address - Phone:513-233-6980
Practice Address - Fax:513-233-6983
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234954207R00000X
OH35.078005207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010272912Medicaid
VA188196OtherBLUE CROSS BLUE SHIELD
VAP00283209OtherRAILROAD MEDICARE
VA00W956P08Medicare ID - Type Unspecified
VAP00283209OtherRAILROAD MEDICARE