Provider Demographics
NPI:1093733495
Name:FOWLER, AMBER D (MD)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:D
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1600 CONTINENTAL PL
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-5607
Mailing Address - Country:US
Mailing Address - Phone:360-336-3026
Mailing Address - Fax:360-428-4227
Practice Address - Street 1:1600 CONTINENTAL PL
Practice Address - Street 2:SUITE # 101
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5607
Practice Address - Country:US
Practice Address - Phone:360-336-3026
Practice Address - Fax:360-428-4227
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00046521207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00046521OtherSTATE LICENSE NUMBER
WA8861481Medicare PIN
WAMD00046521OtherSTATE LICENSE NUMBER
WAI59823Medicare UPIN
WAP73421Medicare UPIN
WA8878079Medicare PIN