Provider Demographics
NPI:1508966573
Name:BOWERS, LEO CLAYTON (MD)
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:CLAYTON
Last Name:BOWERS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 WINE ST
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-3584
Mailing Address - Country:US
Mailing Address - Phone:757-728-1100
Mailing Address - Fax:757-728-0870
Practice Address - Street 1:26 WINE ST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-3584
Practice Address - Country:US
Practice Address - Phone:757-728-1100
Practice Address - Fax:757-728-0870
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033148208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5637341Medicaid
VA005114OtherANTHEM
VA080002422Medicare ID - Type Unspecified
VA005114OtherANTHEM