Provider Demographics
NPI:1861446221
Name:BOWERS, G. WILSON (MD)
Entity Type:Individual
Prefix:
First Name:G.
Middle Name:WILSON
Last Name:BOWERS
Suffix:
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 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-395-8805
Mailing Address - Fax:740-395-8855
Practice Address - Street 1:280 PATTONSVILLE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-9452
Practice Address - Country:US
Practice Address - Phone:740-395-8805
Practice Address - Fax:740-395-8855
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-1628208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0113648OtherMOLINA MEDICAID
OH310917085056OtherCARESOURCE MEDICAID
370002074OtherRR MEDICARE
WV0112101000Medicaid
OH000000181836OtherUNISON MEDICAID
OH0113648Medicaid
370002074OtherRR MEDICARE
F05121Medicare UPIN