Provider Demographics
NPI:1629003181
Name:FOWLER, C PATRICK
Entity Type:Individual
Prefix:MR
First Name:C
Middle Name:PATRICK
Last Name:FOWLER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CLARENCE
Other - Middle Name:PATRICK
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1200 MAIN ST
Mailing Address - Street 2:STE 301A
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3213
Mailing Address - Country:US
Mailing Address - Phone:803-261-0742
Mailing Address - Fax:803-477-3018
Practice Address - Street 1:1200 MAIN ST
Practice Address - Street 2:STE 301A
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3213
Practice Address - Country:US
Practice Address - Phone:803-261-0742
Practice Address - Fax:803-477-3018
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor