Provider Demographics
NPI:1265438972
Name:OMURA, EMILY FOWLER (MD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:FOWLER
Last Name:OMURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MARTHA
Other - Middle Name:EMILY
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3550 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5710
Mailing Address - Country:US
Mailing Address - Phone:205-949-2806
Mailing Address - Fax:205-949-2875
Practice Address - Street 1:3550 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-5710
Practice Address - Country:US
Practice Address - Phone:205-949-2806
Practice Address - Fax:205-949-2875
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4088207ZD0900X
FLME89014207ZD0900X
NC207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D84024Medicare UPIN