| Heather L Bowles | |
|
4390 Pine Crest Dr Larue TX 75770-4758 | |
| (800) 478-7902 | |
| (800) 517-3583 |
| Full Name | Heather L Bowles |
|---|---|
| Speciality | General Practice |
| Location | 4390 Pine Crest Dr, Larue, Texas |
| Authorized Official Name and Position | Heather L Bowles (OWNER/CEO) |
| Authorized Official Contact | 8004787902 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Heather L Bowles 4390 Pine Crest Dr Larue TX 75770-4758 Ph: (800) 478-7902 | Heather L Bowles 4390 Pine Crest Dr Larue TX 75770-4758 Ph: (800) 478-7902 |
| NPI Number | 1114151974 |
|---|---|
| Provider Enumeration Date | 05/08/2009 |
| Last Update Date | 03/16/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114151974 | NPI | - | NPPES |
| 204751601 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |