1891790499 NPI number — DR. JAMES J FOWLER M.D.

Table of content: DR. JAMES J FOWLER M.D. (NPI 1891790499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891790499 NPI number — DR. JAMES J FOWLER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOWLER
Provider First Name:
JAMES
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891790499
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2510 CROCKETT DR STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROWNWOOD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76801-5928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-646-9956
Provider Business Mailing Address Fax Number:
325-641-1010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2510 CROCKETT DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNWOOD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76801-5928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-646-9956
Provider Business Practice Location Address Fax Number:
325-641-1010
Provider Enumeration Date:
06/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  J5576 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4230462 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 126625604 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0019CU . This is a "BCBS - BROWNWOOD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 180953102 . This is a "UNITED HEALTHCARE PROV NO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1844073001 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 89119G . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 040012679 . This is a "RR MEDICARE - BROWNWOOD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 040015413 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 112950100 . This is a "FIRST CARE PROVIDER NUMBE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 126625601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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