Provider Demographics
NPI:1518061001
Name:CENTRAL TEXAS ENT ASSOCIATES INC.
Entity Type:Organization
Organization Name:CENTRAL TEXAS ENT ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-646-9956
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5576207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126625601Medicaid
TX126625601Medicaid
G68227Medicare UPIN