Basic Information
| Provider Information | |||||||||
| NPI: | 1902056708 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOWERS | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 S DOBSON RD STE 39 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852245677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807775888 | ||||||||
| FaxNumber: | 4807778996 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 S DOBSON RD STE 39 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852245677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807775888 | ||||||||
| FaxNumber: | 4807778996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2008 | ||||||||
| LastUpdateDate: | 08/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 4280 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | 4280 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 442901 | 05 | AZ | MEDICAID |