Provider Demographics
NPI:1750130738
Name:BOWERS, JOHN JR (CEO DEJESUSBOWERS IN)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:BOWERS
Suffix:JR
Gender:M
Credentials:CEO DEJESUSBOWERS IN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14848 EDGEMERE DR FL USA
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-0690
Mailing Address - Country:US
Mailing Address - Phone:850-619-8454
Mailing Address - Fax:
Practice Address - Street 1:14848 EDGEMERE DR FL USA
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-0690
Practice Address - Country:US
Practice Address - Phone:850-619-8454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLB620479563820172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver