Provider Demographics
NPI:1548865587
Name:GASPER BOWLES, LESHEQUA
Entity type:Individual
Prefix:
First Name:LESHEQUA
Middle Name:
Last Name:GASPER BOWLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LESHEQUA
Other - Middle Name:
Other - Last Name:GASPER BOWLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22721 SONORA DR
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-4296
Mailing Address - Country:US
Mailing Address - Phone:346-932-6451
Mailing Address - Fax:832-201-7590
Practice Address - Street 1:22721 SONORA DR
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-4296
Practice Address - Country:US
Practice Address - Phone:346-932-6451
Practice Address - Fax:832-201-7590
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1019686207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty