Provider Demographics
NPI:1285679100
Name:FOWLES, THOMAS W (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:FOWLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:942 W MAIN ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-2523
Mailing Address - Country:US
Mailing Address - Phone:731-571-9223
Mailing Address - Fax:931-901-1239
Practice Address - Street 1:942 W MAIN ST UNIT B
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-2523
Practice Address - Country:US
Practice Address - Phone:606-392-2207
Practice Address - Fax:606-392-2139
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY38140207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00372184OtherRAILROAD MEDICARE
KY261QP2300XOtherPRIMARY CARE PHYSICIAN
KY64102726Medicaid
KY38140OtherFAMILY PRACTICE
KY0650720Medicare PIN
I38020Medicare UPIN