Provider Demographics
NPI:1366445066
Name:BOWYER, DARRELL LYNN (MD,PA)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:LYNN
Last Name:BOWYER
Suffix:
Gender:M
Credentials:MD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11797 SOUTH FWY
Mailing Address - Street 2:STE 250
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7035
Mailing Address - Country:US
Mailing Address - Phone:817-293-8330
Mailing Address - Fax:817-293-8394
Practice Address - Street 1:11797 SOUTH FWY
Practice Address - Street 2:STE 250
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7035
Practice Address - Country:US
Practice Address - Phone:817-293-8330
Practice Address - Fax:817-293-8394
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3053207VX0000X, 207V00000X
TX752491299174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099136601Medicaid
TX752491299OtherTAX ID.#
TX1366445066Medicaid