Provider Demographics
NPI:1932179207
Name:BOWER, STEVEN C (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:C
Last Name:BOWER
Suffix:
Gender:M
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 730729
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32173-0729
Mailing Address - Country:US
Mailing Address - Phone:386-586-1780
Mailing Address - Fax:
Practice Address - Street 1:61 MEMORIAL MEDICAL PKWY
Practice Address - Street 2:SUITE 3807
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-5981
Practice Address - Country:US
Practice Address - Phone:386-586-1780
Practice Address - Fax:386-586-1781
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0086908208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266553100Medicaid
G78112Medicare UPIN
FL266553100Medicaid