Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | D0052005 | MD |
NPI | 1043206873 |
---|---|
Provider Name | Lester Bowser |
First Address | Baltimore, MD 21208-6391 |
Second Address | Baltimore, MD 21208-6391 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I33604 | (02) | MD |