Provider Demographics
NPI:1962660225
Name:BOWERS, BRIEN O
Entity Type:Individual
Prefix:
First Name:BRIEN
Middle Name:O
Last Name:BOWERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 WATERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7074
Mailing Address - Country:US
Mailing Address - Phone:352-365-1842
Mailing Address - Fax:352-365-9878
Practice Address - Street 1:202 WATERS EDGE DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7074
Practice Address - Country:US
Practice Address - Phone:352-365-1842
Practice Address - Fax:352-365-9878
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL693305096Medicaid
FL693305098Medicaid