Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 41473 | KY |
N | 208600000X | Surgeon | 41473 | KY |
N | 2086X0206X | Surgical Oncologist | 41473 | KY |
Y | 2086X0206X | Surgical Oncologist | ME104932 | FL |
NPI | 1174710982 |
---|---|
Provider Name | Carol Patricia Robertine Bowen-Wells |
First Address | Jacksonville, FL 32204-4776 |
Second Address | Jacksonville, FL 32204-4776 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2007 |
Last Update Date | 14/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0013091-00 | (05) | FL |
37903705 | MEDICAID LAB GROUP (01) | KY |
4000501 | MEDICARE LAB GROUP (01) | KY |