Provider Demographics
NPI:1922621101
Name:FOWLER, BENJAMIN LUKE (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LUKE
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 1:300 HILLMONT AVE.
Mailing Address - Street 2:BLDG 340, STE 101 & 201
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003
Mailing Address - Country:US
Mailing Address - Phone:805-652-6100
Mailing Address - Fax:
Practice Address - Street 1:300 HILLMONT AVE.
Practice Address - Street 2:BLDG 340, STE 101 & 201
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-652-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program