Provider Demographics
NPI:1861735086
Name:BOWERS, CLIFFORD WILLIAM III (DO)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:WILLIAM
Last Name:BOWERS
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 INDIAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-5147
Mailing Address - Country:US
Mailing Address - Phone:864-310-3724
Mailing Address - Fax:
Practice Address - Street 1:700 SQUIRES PT STE B
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334-8879
Practice Address - Country:US
Practice Address - Phone:864-428-9959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39095207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC84706067OtherMEDICARE PIN
SCSC8470J577OtherMEDICARE PIN
SC390954Medicaid
SCSC84706121OtherMEDICARE PIN
SCP01771964OtherRAILROAD MEDICARE