Provider Demographics
NPI:1568621340
Name:FOWLER, GINA (DO)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S FM 1187
Mailing Address - Street 2:300
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-6449
Mailing Address - Country:US
Mailing Address - Phone:817-441-2266
Mailing Address - Fax:877-397-0469
Practice Address - Street 1:311 S FM 1187
Practice Address - Street 2:300
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008
Practice Address - Country:US
Practice Address - Phone:817-441-2266
Practice Address - Fax:877-293-3512
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9285208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics