Provider Demographics
NPI:1730279902
Name:BOWERS, DUSTIN (PA-C)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:BOWERS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 E PHILADELPHIA STREET EXT
Mailing Address - Street 2:
Mailing Address - City:ARMAGH
Mailing Address - State:PA
Mailing Address - Zip Code:15920-9200
Mailing Address - Country:US
Mailing Address - Phone:814-446-6915
Mailing Address - Fax:
Practice Address - Street 1:1590 N CENTER AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-7019
Practice Address - Country:US
Practice Address - Phone:814-443-1281
Practice Address - Fax:814-443-3214
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052638363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant