Doctor Name: | MR. DWIGHT RAYMOND BOWERMAN |
NPI Number: | 1780716779 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | SA1103 |
Business Practice Address: | 204 Us 27 S Lake Placid, FL - 338527900 |
Business Phone Number: | 8634659500 |
Business Fax Number: | |
Mailing Address: | 149 Pendarvis Rd, LAKE PLACID |
State: | FL |
Postal Code: | 338526817 |
Phone Number: | 8634653612 |
Fax Number: | |
NPI Enumeration Date: | 03/12/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SA1103 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |