Provider Demographics
NPI:1164402095
Name:HOWERTER, BERNARD EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:EDWARD
Last Name:HOWERTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:B.
Other - Middle Name:E
Other - Last Name:HOWERTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1400 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-3306
Mailing Address - Country:US
Mailing Address - Phone:620-252-1629
Mailing Address - Fax:620-252-1541
Practice Address - Street 1:1400 W 4TH ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-3306
Practice Address - Country:US
Practice Address - Phone:620-252-1629
Practice Address - Fax:620-252-1541
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0415260208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100081680AMedicaid
KS000432Medicare ID - Type Unspecified
KSB68257Medicare UPIN