Provider Demographics
NPI:1801844030
Name:BOWERS, GARY J (M D)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:BOWERS
Suffix:
Gender:M
Credentials:M D
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Mailing Address - Street 1:11945 SAN JOSE BLVD
Mailing Address - Street 2:BLDG 300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1627
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-399-1717
Practice Address - Street 1:836 PRUDENTIAL DR
Practice Address - Street 2:SUITE 1107
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8338
Practice Address - Country:US
Practice Address - Phone:904-398-0033
Practice Address - Fax:904-398-6774
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0046671208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1732633OtherCIGNA
209665OtherAVMED
23323OtherBCBS FL
020053793OtherRAILROAD MEDICARE
4420181OtherAETNA
020053793OtherRAILROAD MEDICARE
4420181OtherAETNA