Provider Demographics
NPI:1659478303
Name:BOWER, LAURENCE ROBERT III (MD)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:ROBERT
Last Name:BOWER
Suffix:III
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 1:128 W BANDERA RD STE 4
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2905
Mailing Address - Country:US
Mailing Address - Phone:830-816-5518
Mailing Address - Fax:830-331-1042
Practice Address - Street 1:128 W BANDERA RD STE 4
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2905
Practice Address - Country:US
Practice Address - Phone:830-816-5518
Practice Address - Fax:830-331-1042
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8926208M00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX036280802Medicaid
TX8EE312OtherBCBS TX
TXG25079Medicare UPIN
TX157938501Medicaid