Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 1866 | NE |
NPI | 1003357427 |
---|---|
Provider Name | Alexander L Bowers |
First Address | Fort Irwin, CA 92310 |
Second Address | Tacoma, WA 98431-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2017 |
Last Update Date | 25/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1866 | NEBRASKA PHYSICIAN LICENSE (01) | NE |