Provider Demographics
NPI:1164711693
Name:FOWLER, CARLA (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 BROADWAY # 547
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-3854
Mailing Address - Country:US
Mailing Address - Phone:206-852-0952
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR RM H3691
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:206-852-0952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program