Provider Demographics
NPI:1619927126
Name:FOWLER, STEVEN C (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:C
Last Name:FOWLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5067
Mailing Address - Country:US
Mailing Address - Phone:563-243-2511
Mailing Address - Fax:563-243-6081
Practice Address - Street 1:1021 11TH ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:IA
Practice Address - Zip Code:52742-1209
Practice Address - Country:US
Practice Address - Phone:563-659-9294
Practice Address - Fax:563-659-8104
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA30991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA43636OtherWELLMARK BC/BS
8946OtherMIDLANDS CHOICE
IA7142752Medicaid
072177OtherHEALTH ALLIANCE
35987OtherIOWA HEALTH SOLUTIONS
IA 0191OtherJOHN DEERE HEALTH
IL$$$$$$$$$Medicaid
IAI5074Medicare PIN
072177OtherHEALTH ALLIANCE
G39746Medicare UPIN