Provider Demographics
NPI:1881044006
Name:FOWLER, TRISTAN ROSS PEREGRINO (DO)
Entity Type:Individual
Prefix:DR
First Name:TRISTAN
Middle Name:ROSS PEREGRINO
Last Name:FOWLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4840 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1601
Mailing Address - Country:US
Mailing Address - Phone:913-491-6878
Mailing Address - Fax:913-491-3172
Practice Address - Street 1:4840 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1601
Practice Address - Country:US
Practice Address - Phone:913-491-6878
Practice Address - Fax:913-491-3172
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-18
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101022338207V00000X
KS05-43441207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology