Provider Demographics
NPI:1487028189
Name:BOWERS, THOMAS JR (CRNA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BOWERS
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3192 W 200 N
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-7539
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2801 NW 79TH AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1174
Practice Address - Country:US
Practice Address - Phone:786-466-1154
Practice Address - Fax:786-466-1358
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN700952367500000X
IN28180492A367500000X
FLAPRN9366405367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001024914OtherANTHEM PROVIDER NUMBER UNDER TIN 35-2030653
IN201346220Medicaid
IN201346220Medicaid