Provider Demographics
NPI:1073807301
Name:LAURIE B FOWLER
Entity Type:Organization
Organization Name:LAURIE B FOWLER
Other - Org Name:FOWLER ALLERGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-474-9302
Mailing Address - Street 1:1506 CHAPEL HILL RD STE G
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5504
Mailing Address - Country:US
Mailing Address - Phone:573-474-9302
Mailing Address - Fax:573-474-8299
Practice Address - Street 1:1506 CHAPEL HILL RD STE G
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5504
Practice Address - Country:US
Practice Address - Phone:573-474-9302
Practice Address - Fax:573-474-8299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD103556174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty