Provider Demographics
NPI:1174710982
Name:BOWEN-WELLS, CAROL PATRICIA ROBERTINE (MD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:PATRICIA ROBERTINE
Last Name:BOWEN-WELLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SHIRCLIFF WAY
Mailing Address - Street 2:SUITE 630
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4776
Mailing Address - Country:US
Mailing Address - Phone:904-281-5878
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:3 SHIRCLIFF WAY
Practice Address - Street 2:SUITE 630
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4776
Practice Address - Country:US
Practice Address - Phone:904-281-5878
Practice Address - Fax:904-645-5856
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41473208600000X, 2086X0206X
FLME1049322086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY37903705OtherMEDICAID LAB GROUP
KY4000501OtherMEDICARE LAB GROUP
FL0013091-00Medicaid
KY0092728Medicare PIN
FL0013091-00Medicaid