Provider Demographics
NPI:1508817628
Name:FOWLER, STEVEN R (PA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:FOWLER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 HARVEST HILL RD STE 290
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-5826
Mailing Address - Country:US
Mailing Address - Phone:214-420-0650
Mailing Address - Fax:
Practice Address - Street 1:601 MALLARD LN STE A
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574-1214
Practice Address - Country:US
Practice Address - Phone:737-270-7730
Practice Address - Fax:737-270-7731
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102548363A00000X
UT368197-1206363A00000X
NVPA1314363A00000X
TXPA14351363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1508ZMedicare ID - Type Unspecified