Provider Demographics
NPI:1952333056
Name:BOWER, STEPHEN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LEE
Last Name:BOWER
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 1:1649 S MARBLEHEAD RD
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-7791
Mailing Address - Country:US
Mailing Address - Phone:336-945-4283
Mailing Address - Fax:336-945-6813
Practice Address - Street 1:1649 S MARBLEHEAD RD
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27023-7791
Practice Address - Country:US
Practice Address - Phone:336-945-4283
Practice Address - Fax:336-945-6813
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC246352085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8917114Medicaid
213783Medicare ID - Type Unspecified
NC213783KMedicare PIN
C87066Medicare UPIN
NC8917114Medicaid