1033260849 NPI number — DR. WILLIAM E FOWLER PHD., M.P.

Table of content: DR. WILLIAM E FOWLER PHD., M.P. (NPI 1033260849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033260849 NPI number — DR. WILLIAM E FOWLER PHD., M.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOWLER
Provider First Name:
WILLIAM
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD., M.P.
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:
1033260849
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 OLD SPANISH TRL
Provider Second Line Business Mailing Address:
#203
Provider Business Mailing Address City Name:
SLIDELL
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70458-8601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-781-0548
Provider Business Mailing Address Fax Number:
888-414-4319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3351 SEVERN AVE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70002-7414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-975-1659
Provider Business Practice Location Address Fax Number:
504-288-0091
Provider Enumeration Date:
01/16/2007

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: 103TC2200X , with the licence number:  665 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TP0016X , with the licence number: MP000033 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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