Provider Demographics
NPI:1689432049
Name:SHOWELL, BRYCE
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:
Last Name:SHOWELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08104-2359
Mailing Address - Country:US
Mailing Address - Phone:856-739-1833
Mailing Address - Fax:
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2025-04-24
Deactivation Date:2025-03-25
Deactivation Code:
Reactivation Date:2025-04-24
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4351054007207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program