Provider Demographics
NPI:1659504801
Name:BOWERS, CODY A (DPM)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:A
Last Name:BOWERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MILLTOWN RD
Mailing Address - Street 2:SUITE 24
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4027
Mailing Address - Country:US
Mailing Address - Phone:302-998-0178
Mailing Address - Fax:302-999-0700
Practice Address - Street 1:1601 MILLTOWN RD
Practice Address - Street 2:SUITE 24
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4027
Practice Address - Country:US
Practice Address - Phone:302-998-0178
Practice Address - Fax:302-999-0700
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1-0000192213E00000X, 213ES0103X
PASC0005926213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE159782Medicare PIN