Provider Demographics
NPI:1235575044
Name:FOWLER, TROY W (DPM)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:W
Last Name:FOWLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 12TH AVE RD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5012
Mailing Address - Country:US
Mailing Address - Phone:208-466-3338
Mailing Address - Fax:208-466-3554
Practice Address - Street 1:203 12TH AVE RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-5012
Practice Address - Country:US
Practice Address - Phone:208-466-3338
Practice Address - Fax:208-466-3554
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP-257213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
13505181Medicare PIN