Provider Demographics
NPI:1700871951
Name:MOWETT, INDA M (MD)
Entity Type:Individual
Prefix:DR
First Name:INDA
Middle Name:M
Last Name:MOWETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5219 E STATE ROAD 64
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-9009
Mailing Address - Country:US
Mailing Address - Phone:941-749-0741
Mailing Address - Fax:941-748-8426
Practice Address - Street 1:5219 E STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-5533
Practice Address - Country:US
Practice Address - Phone:941-749-0741
Practice Address - Fax:941-748-8426
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG37276Medicare UPIN
FL51794YMedicare PIN
FL51794OtherBCBS
FL80161625OtherRAIL ROAD MEDICARE
FL51794YMedicare PIN