Provider Demographics
NPI:1366720369
Name:BOWERS, REBECCA J (DO)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:BOWERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 HARTNESS DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5489
Mailing Address - Country:US
Mailing Address - Phone:864-417-5255
Mailing Address - Fax:
Practice Address - Street 1:4006 E NORTH ST
Practice Address - Street 2:STE C
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6206
Practice Address - Country:US
Practice Address - Phone:864-417-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC37584207Q00000X
SC2837584204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC375846Medicaid
SC375846Medicaid