Provider Demographics
NPI:1306006275
Name:BOWSER, STACEY M (DO)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:M
Last Name:BOWSER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:M
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1709 NORRIS ST
Mailing Address - Street 2:
Mailing Address - City:SAXTON
Mailing Address - State:PA
Mailing Address - Zip Code:16678-1435
Mailing Address - Country:US
Mailing Address - Phone:814-635-2801
Mailing Address - Fax:814-635-2470
Practice Address - Street 1:1709 NORRIS ST
Practice Address - Street 2:
Practice Address - City:SAXTON
Practice Address - State:PA
Practice Address - Zip Code:16678-1435
Practice Address - Country:US
Practice Address - Phone:814-635-2801
Practice Address - Fax:814-635-2470
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARES0000Medicare UPIN