Provider Demographics
NPI:1023165925
Name:BOWSER, DONALD L (NP)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:L
Last Name:BOWSER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:520 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4334
Mailing Address - Country:US
Mailing Address - Phone:541-789-5704
Mailing Address - Fax:541-789-5989
Practice Address - Street 1:520 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4334
Practice Address - Country:US
Practice Address - Phone:541-789-5704
Practice Address - Fax:541-789-5989
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR080046081N3ANP-PP207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR113790Medicare UPIN