Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 019-024681 | IL |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN21082 | FL |
NPI | 1083693055 |
---|---|
Provider Name | Daniel Leon Bower |
First Address | Tallahassee, FL 32308-5371 |
Second Address | Tallahassee, FL 32308-5371 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 16/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000OTH | (02) |