Provider Demographics
NPI:1598753311
Name:BOWER, KEVIN RUDY (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:RUDY
Last Name:BOWER
Suffix:
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 1:800 GATESHEAD CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6363
Mailing Address - Country:US
Mailing Address - Phone:817-481-6590
Mailing Address - Fax:
Practice Address - Street 1:1901 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2220
Practice Address - Country:US
Practice Address - Phone:972-579-8110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7169207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82246FOtherBCBS
TX8K9551OtherBCBS
TX8K9551OtherBCBS
TXP00176354Medicare PIN
TXB62066Medicare UPIN
TX8B7725Medicare PIN
TX82246FMedicare PIN