Provider Demographics
NPI:1174043814
Name:STOWERS, JERED (DPM)
Entity type:Individual
Prefix:
First Name:JERED
Middle Name:
Last Name:STOWERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5471 GEORGETOWN RD STE C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5794
Mailing Address - Country:US
Mailing Address - Phone:317-297-0661
Mailing Address - Fax:317-328-6338
Practice Address - Street 1:8615 US 31 S STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-0972
Practice Address - Country:US
Practice Address - Phone:317-888-0560
Practice Address - Fax:317-888-0657
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN07001354A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery