Provider Demographics
NPI:1235146010
Name:BOWERS, LORI ANN (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:BOWERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 18TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6481
Mailing Address - Country:US
Mailing Address - Phone:772-925-8200
Mailing Address - Fax:772-925-8199
Practice Address - Street 1:981 37TH PL
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6541
Practice Address - Country:US
Practice Address - Phone:772-257-5785
Practice Address - Fax:772-257-5325
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76869208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261935100Medicaid
FL01949OtherBLUE CROSS BLUE SHIELD
FL01949YMedicare PIN
FL01949OtherBLUE CROSS BLUE SHIELD