Provider Demographics
NPI:1609950492
Name:ANDERSON-FOWLER, MARGO K (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGO
Middle Name:K
Last Name:ANDERSON-FOWLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2714
Mailing Address - Country:US
Mailing Address - Phone:402-506-9067
Mailing Address - Fax:402-315-2734
Practice Address - Street 1:7100 W CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2714
Practice Address - Country:US
Practice Address - Phone:402-506-9067
Practice Address - Fax:402-315-2734
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18837207Q00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1609950492Medicaid
NE47068731749Medicaid
NE47068731741Medicaid
NE47068731734Medicaid
NE47068731785Medicaid
NE47068731785Medicaid