Provider Demographics
NPI:1508030693
Name:RICHARD F FOWLER MD PC
Entity Type:Organization
Organization Name:RICHARD F FOWLER MD PC
Other - Org Name:ARIZONA CENTER FOR INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-830-4164
Mailing Address - Street 1:6315 E MAIN ST
Mailing Address - Street 2:STE 4
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-8953
Mailing Address - Country:US
Mailing Address - Phone:480-830-4164
Mailing Address - Fax:480-830-5009
Practice Address - Street 1:6315 E MAIN ST
Practice Address - Street 2:STE 4
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8953
Practice Address - Country:US
Practice Address - Phone:480-830-4164
Practice Address - Fax:480-830-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16349207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ110123001OtherRAILROAD MEDICARE
AZD36861Medicare UPIN
AZZWCLDBMedicare PIN