Provider Demographics
NPI:1497989081
Name:BOWERS, COLBY J (IDMT)
Entity Type:Individual
Prefix:MR
First Name:COLBY
Middle Name:J
Last Name:BOWERS
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5656 TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT DIX
Mailing Address - State:NJ
Mailing Address - Zip Code:08640-5403
Mailing Address - Country:US
Mailing Address - Phone:609-754-7253
Mailing Address - Fax:
Practice Address - Street 1:5656 TEXAS AVE
Practice Address - Street 2:
Practice Address - City:FORT DIX
Practice Address - State:NJ
Practice Address - Zip Code:08640-5403
Practice Address - Country:US
Practice Address - Phone:609-754-7253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians