Provider Demographics
NPI:1780688598
Name:FOWLER-GULDE, JANIS J (MD)
Entity Type:Individual
Prefix:DR
First Name:JANIS
Middle Name:J
Last Name:FOWLER-GULDE
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 1:2 N FLAMINGO ST
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-6528
Mailing Address - Country:US
Mailing Address - Phone:409-440-9336
Mailing Address - Fax:888-443-3008
Practice Address - Street 1:6801 DELANY RD
Practice Address - Street 2:
Practice Address - City:HITCHCOCK
Practice Address - State:TX
Practice Address - Zip Code:77563-1734
Practice Address - Country:US
Practice Address - Phone:409-986-5521
Practice Address - Fax:409-986-9625
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1438207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118049906Medicaid
TX8C7325Medicare ID - Type Unspecified
TXG23823Medicare UPIN