Provider Demographics
NPI:1366435356
Name:BOWER, PHILLIP JEFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:JEFFREY
Last Name:BOWER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-5747
Mailing Address - Country:US
Mailing Address - Phone:843-782-2788
Mailing Address - Fax:843-782-2797
Practice Address - Street 1:302 MEDICAL PARK DR
Practice Address - Street 2:SUITE 207
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-5747
Practice Address - Country:US
Practice Address - Phone:843-782-2788
Practice Address - Fax:843-782-2797
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22458207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0624Medicaid
SCGP0624Medicaid
SCB889304251Medicare ID - Type Unspecified