Provider Demographics
NPI:1811266943
Name:LOUIS B FOWLER JR MD PA
Entity type:Organization
Organization Name:LOUIS B FOWLER JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:850-433-9391
Mailing Address - Street 1:431 E GOVERNMENT ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-6131
Mailing Address - Country:US
Mailing Address - Phone:850-433-9391
Mailing Address - Fax:850-433-5881
Practice Address - Street 1:431 E GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-6131
Practice Address - Country:US
Practice Address - Phone:850-433-9391
Practice Address - Fax:850-433-5881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33553261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care