Provider Demographics
NPI:1326065012
Name:FOWBLE, VINCENT A (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:A
Last Name:FOWBLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:108 INTRACOASTAL POINTE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-5036
Mailing Address - Country:US
Mailing Address - Phone:561-900-7124
Mailing Address - Fax:561-330-6606
Practice Address - Street 1:108 INTRACOASTAL POINTE DR STE 200
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-5036
Practice Address - Country:US
Practice Address - Phone:561-900-7124
Practice Address - Fax:561-330-6606
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94144207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6170ZMedicare PIN
F96362Medicare UPIN
FL274503800Medicaid