Provider Demographics
NPI:1447362066
Name:BOWERSOX, HAROLD JONATHAN (DO)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:JONATHAN
Last Name:BOWERSOX
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 714328
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-4328
Mailing Address - Country:US
Mailing Address - Phone:440-354-1899
Mailing Address - Fax:440-354-1845
Practice Address - Street 1:9500 MENTOR AVE
Practice Address - Street 2:SUITE 360
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8713
Practice Address - Country:US
Practice Address - Phone:440-255-5508
Practice Address - Fax:440-357-4416
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-003486207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000210429OtherANTHEM
OH080180930OtherRAILROAD MEDICARE
OH0548447Medicaid
OH0548447Medicaid