Provider Demographics
NPI:1538253083
Name:BOWERS, SHERRY LYNN (DPM)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:BOWERS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 W MAGNOLIA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4351
Mailing Address - Country:US
Mailing Address - Phone:817-522-1530
Mailing Address - Fax:817-523-8667
Practice Address - Street 1:1305 W MAGNOLIA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4351
Practice Address - Country:US
Practice Address - Phone:817-522-1530
Practice Address - Fax:817-523-8667
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1387213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112182402Medicaid
TX8F4935Medicare PIN
TX112182402Medicaid