Provider Demographics
NPI:1558396002
Name:BOWERS, WALTER THOMAS II (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:THOMAS
Last Name:BOWERS
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 AUBURN AVE
Mailing Address - Street 2:ATTN: PAYOR RELATIONS
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-381-6161
Mailing Address - Fax:513-381-6171
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-381-6161
Practice Address - Fax:513-381-6171
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039566207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0394149Medicaid
OH0394149Medicaid
OHD31212Medicare UPIN