Provider Demographics
NPI:1376698860
Name:DR BRAD STOWERS DPM PLLC
Entity Type:Organization
Organization Name:DR BRAD STOWERS DPM PLLC
Other - Org Name:SOUTH TEXAS PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRAD
Authorized Official - Last Name:STOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:956-682-8391
Mailing Address - Street 1:3109 CENTER POINT DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8433
Mailing Address - Country:US
Mailing Address - Phone:956-682-8391
Mailing Address - Fax:956-682-0018
Practice Address - Street 1:3109 CENTER POINT DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8433
Practice Address - Country:US
Practice Address - Phone:956-682-8391
Practice Address - Fax:956-682-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0900213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081446901Medicaid
TX4171320001Medicare NSC
TX081446901Medicaid