Provider Demographics
NPI:1265478408
Name:FOWLER, LISA S (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2510 CROCKETT DR
Mailing Address - Street 2:STE A
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-5928
Mailing Address - Country:US
Mailing Address - Phone:325-646-9956
Mailing Address - Fax:325-641-1010
Practice Address - Street 1:2510 CROCKETT DR
Practice Address - Street 2:STE A
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5928
Practice Address - Country:US
Practice Address - Phone:325-646-9956
Practice Address - Fax:325-641-1010
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2018-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ4122207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGOtherRAILROAD MEDICARE
TX125584607Medicaid
TX547510YVCYMedicare PIN
TXPENDINGOtherRAILROAD MEDICARE