Provider Demographics
NPI:1821022823
Name:FOWLER, MARJORIE REES (MD)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:REES
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 33932
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71130-3932
Mailing Address - Country:US
Mailing Address - Phone:318-675-5868
Mailing Address - Fax:318-675-8589
Practice Address - Street 1:1501 KINGS HWY
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:318-675-5868
Practice Address - Fax:318-675-8589
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA010888207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA270219YH54OtherMEDICARE - PTAN
LA1436593Medicaid
LAB61281Medicare UPIN