Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | C-6793 | AR |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | C-6793 | AR |
NPI | 1184714677 |
---|---|
Provider Name | Charles Bower |
First Address | Little Rock, AR 72202-3500 |
Second Address | Springdale, AR 72762-0845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 05/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
117391001 | (05) | AR |
D04568 | (02) |