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Organization
TKB FOWLER DO INC
Active
Organization
TKB FOWLER DO INC
Active
Other names
Genesis Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY KB FOWLER DO (PRESIDENT)
(714) 522-2891
Entity
Organization
Contact information
Practice address
6189 LA PALMA AVE, BUENA PARK, CA 90620-2858
(714) 522-2891
(714) 522-8176
Mailing address
6189 LA PALMA AVE, BUENA PARK, CA 90620-2858
(714) 522-2891
(714) 522-8176
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
00AX78810
CA
207Q00000X
Family Medicine Physician
20A7613
CA
207Q00000X
Family Medicine Physician
Primary
20A7881
CA
207Q00000X
Family Medicine Physician
A43569
CA
Other
Enumeration date
02/12/2007
Last updated
07/03/2008
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