Provider Demographics
NPI:1851690697
Name:FOWLER, JASON DEAN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:DEAN
Last Name:FOWLER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 S CLIFF AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1009
Mailing Address - Country:US
Mailing Address - Phone:605-322-4130
Mailing Address - Fax:
Practice Address - Street 1:1417 S CLIFF AVE STE 200
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1009
Practice Address - Country:US
Practice Address - Phone:605-322-4130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN56875208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery