Provider Demographics
NPI:1164468674
Name:FOWLER, TODD E (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:E
Last Name:FOWLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:1724 HAMILL RD STE 102
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5098
Practice Address - Country:US
Practice Address - Phone:423-267-6738
Practice Address - Fax:423-635-7544
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD29755207Y00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ013022Medicaid
3815157Medicare UPIN