Provider Demographics
NPI:1871511345
Name:BOWER, RICHARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:BOWER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:C B 8221
Mailing Address - Street 2:7425 FORSYTH
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2161
Mailing Address - Country:US
Mailing Address - Phone:314-454-6022
Mailing Address - Fax:314-454-2442
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6022
Practice Address - Fax:314-454-2442
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR42852086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0510169011Medicaid
A12817Medicare UPIN