Provider Demographics
NPI:1043339880
Name:W.R. FOWLER, M.D.,LLC
Entity Type:Organization
Organization Name:W.R. FOWLER, M.D.,LLC
Other - Org Name:COPPER MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LE ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:505-388-3393
Mailing Address - Street 1:3185 N LESLIE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7211
Mailing Address - Country:US
Mailing Address - Phone:505-388-3393
Mailing Address - Fax:505-388-2696
Practice Address - Street 1:3185 N LESLIE RD
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7211
Practice Address - Country:US
Practice Address - Phone:505-388-3393
Practice Address - Fax:505-388-2696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM09266Medicaid
NM1790869998OtherNPI FOR W.R. FOWLER, M.D.
NM24736805Medicaid
NM1952342651OtherNPI FOR TERRELL HADLEY
NM1134203334OtherNPI FOR KAREN DEGENEVIEVE
NMZ1351Medicaid
NMS52030Medicare UPIN
NM24736805Medicaid
NMZ1351Medicaid