Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 17450 | WV |
NPI | 1003842089 |
---|---|
Provider Name | Robert John Bowers II |
First Address | Morgantown, WV 26508-4470 |
Second Address | Morgantown, WV 26508-4470 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 13/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0045298000 | (05) | WV |
F76884 | (02) |