Provider Demographics
NPI:1588815138
Name:FOWLER, DORIAN E (CRNA)
Entity Type:Individual
Prefix:
First Name:DORIAN
Middle Name:E
Last Name:FOWLER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DORIAN
Other - Middle Name:Y
Other - Last Name:ELMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:881 KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5456
Mailing Address - Country:US
Mailing Address - Phone:319-850-7607
Mailing Address - Fax:
Practice Address - Street 1:881 KENDALL DR
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5456
Practice Address - Country:US
Practice Address - Phone:319-850-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201408271CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1588815138OtherWELLMARK BLUE CROSS BLUE SHIELD
IA1588815138Medicaid
IAP00662680OtherRAILROAD MEDICARE
IAP00662680OtherRAILROAD MEDICARE