Provider Demographics
NPI: | 1275532251 |
---|---|
Name: | BOWERS, JAMELLE R (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | JAMELLE |
Middle Name: | R |
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: | 2655 COUNTRYLAKE DR |
Mailing Address - Street 2: | |
Mailing Address - City: | CINCINNATI |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45233-1785 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 804-240-0259 |
Mailing Address - Fax: | 513-389-4013 |
Practice Address - Street 1: | 3131 QUEEN CITY AVE |
Practice Address - Street 2: | |
Practice Address - City: | CINCINNATI |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45238-2316 |
Practice Address - Country: | US |
Practice Address - Phone: | 513-389-5289 |
Practice Address - Fax: | 513-389-4013 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-07-20 |
Last Update Date: | 2011-11-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 0101234954 | 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
VA | 010272912 | Medicaid | |
VA | P00283209 | Other | RAILROAD MEDICARE |
VA | 188196 | Other | BLUE CROSS BLUE SHIELD |
VA | 00W956P08 | Medicare ID - Type Unspecified | |
VA | P00283209 | Other | RAILROAD MEDICARE |