1477628006 NPI number — PATRICK T FOWLER MD

Table of content: PATRICK T FOWLER MD (NPI 1477628006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477628006 NPI number — PATRICK T FOWLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOWLER
Provider First Name:
PATRICK
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1477628006
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2624 EDITH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDDING
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96001-3043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-241-3316
Provider Business Mailing Address Fax Number:
530-241-6319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2626 EDITH AVE STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-3056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-241-3316
Provider Business Practice Location Address Fax Number:
530-241-6319
Provider Enumeration Date:
11/21/2006

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: 208800000X , with the licence number:  G78482 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 340016697 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G78482 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G784820 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05D0617976 . This is a "CLIA ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ78528Z , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CP5241 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com