Provider Demographics
NPI:1720031396
Name:BOWES, LEYDA E (MD)
Entity Type:Individual
Prefix:DR
First Name:LEYDA
Middle Name:E
Last Name:BOWES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15051 S TAMIAMI TRL STE 203
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-5182
Mailing Address - Country:US
Mailing Address - Phone:239-437-8810
Mailing Address - Fax:239-313-2555
Practice Address - Street 1:3659 S MIAMI AVE STE 6008
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4221
Practice Address - Country:US
Practice Address - Phone:305-856-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212720207N00000X
FLME79593207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ26971OtherBCBS
FL272187200Medicaid
MA468616OtherTUFFS HEALTH PLAN
FL81426OtherBCBS OF FLORIDA
MA2029090Medicaid
MAA36377Medicare ID - Type Unspecified
MA468616OtherTUFFS HEALTH PLAN
FL272187200Medicaid