Basic Information
| Provider Information | |||||||||
| NPI: | 1962514406 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOWER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | CALVIN | ||||||||
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| Credential: | CAA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3355 GLENDALE AVE. | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436144361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193833556 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | BENNINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 052015004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024474535 | ||||||||
| FaxNumber: | 8024474537 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 09/06/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367H00000X | AAA0000006 | VT | Y | Physician Assistants & Advanced Practice Nursing Providers | Anesthesiologist Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1011952 | 05 | VT | MEDICAID |