Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | R73514 | AZ |
N | 208600000X | Surgeon | R73514 | AZ |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 4301112110 | MI |
NPI | 1063777985 |
---|---|
Provider Name | Harold Dean Bowker III |
First Address | Detroit, MI 48220 |
Second Address | Detroit, MI 48201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2012 |
Last Update Date | 20/06/2017 |