Provider Demographics
NPI:1639112451
Name:FOWLER, JEFFREY M (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
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 1:3651 RIDGE MILL DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7752
Mailing Address - Country:US
Mailing Address - Phone:614-293-3873
Mailing Address - Fax:614-266-8772
Practice Address - Street 1:3651 RIDGE MILL DR
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7752
Practice Address - Country:US
Practice Address - Phone:614-293-3873
Practice Address - Fax:614-293-3078
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01086901A207VX0201X
OH35056039207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0677816Medicaid
IN300057437Medicaid
E28339Medicare UPIN