Provider Demographics
NPI:1003357427
Name:BOWERS, ALEXANDER L (DO)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:L
Last Name:BOWERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:BOWERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:390 NORTH OUTER LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310
Mailing Address - Country:US
Mailing Address - Phone:760-383-5200
Mailing Address - Fax:
Practice Address - Street 1:9040A JACKSON AVE JOINT BASE LEWIS-MCCHORD
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1000
Practice Address - Country:US
Practice Address - Phone:253-968-3066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-18
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NE1866208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1866OtherNEBRASKA PHYSICIAN LICENSE