Basic Information
| Provider Information | |||||||||
| NPI: | 1700273026 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOWSER | ||||||||
| FirstName: | LINDSEY | ||||||||
| MiddleName: | LING | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LING | ||||||||
| OtherFirstName: | LINDSEY | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 220 SW 84TH AVE. | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043087374 | ||||||||
| FaxNumber: | 9043082998 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 SW 84TH AVE. | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8446654827 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2015 | ||||||||
| LastUpdateDate: | 10/15/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 945-L | MS | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | TRN 23754 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | MS | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | ME137042 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 03553090 | 05 | MS | MEDICAID |