Provider Demographics
NPI:1023047339
Name:BOWERS, MARY I (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:I
Last Name:BOWERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W 5TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2748
Mailing Address - Country:US
Mailing Address - Phone:307-672-7700
Mailing Address - Fax:
Practice Address - Street 1:1701 W 5TH ST
Practice Address - Street 2:STE A
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2748
Practice Address - Country:US
Practice Address - Phone:307-672-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5199A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY0000011895OtherMONTANA MEDICAID
WY303760OtherBLUE CROSS
WY0000011895OtherMONTANA MEDICAID