Basic Information
| Provider Information | |||||||||
| NPI: | 1962472019 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOWERS | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | MALCOLM | ||||||||
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| Credential: | MD MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 160 | ||||||||
| Address2: | |||||||||
| City: | SHIPROCK | ||||||||
| State: | NM | ||||||||
| PostalCode: | 874200160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286565000 | ||||||||
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| Practice Location | |||||||||
| Address1: | US HWY 160 & NAVAJO ROUTE 35 - RED MESA | ||||||||
| Address2: | |||||||||
| City: | TEECNOSPOS | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286565000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2006 | ||||||||
| LastUpdateDate: | 04/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 032229 | CT | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.