Provider Demographics
NPI:1053631259
Name:LEE, BOWLVA MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:BOWLVA
Middle Name:MICHAEL
Last Name:LEE
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:720 HIGHWAY 377, SUITE 140, PMB 155
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-6893
Mailing Address - Country:US
Mailing Address - Phone:347-560-1640
Mailing Address - Fax:972-972-8660
Practice Address - Street 1:9441 LBJ FWY SUITE 114
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4635
Practice Address - Country:US
Practice Address - Phone:214-557-4111
Practice Address - Fax:972-972-8660
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2477207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine