Provider Demographics
NPI:1619390622
Name:LAURENCE R BOWER III MD
Entity Type:Organization
Organization Name:LAURENCE R BOWER III MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOWER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:830-331-0125
Mailing Address - Street 1:19A GRUENE PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-2459
Mailing Address - Country:US
Mailing Address - Phone:830-632-7562
Mailing Address - Fax:830-632-6793
Practice Address - Street 1:128 W BANDERA ROAD #4
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006
Practice Address - Country:US
Practice Address - Phone:830-331-0610
Practice Address - Fax:830-331-1042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ89262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1659478303OtherINDIVIDUAL NPI
TX8EE312OtherBCBS
TX157938501Medicaid
TX00U18TMedicare PIN