Individual
GRADY FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2100 LOUISIANA BLVD NE STE 410, ALBUQUERQUE, NM 87110-5412
(505) 724-4300
(505) 338-0034
Mailing address
2100 LOUISIANA BLVD NE, STE 410, ALBUQUERQUE, NM 87110-5412
(505) 724-4300
(505) 338-0034
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
11/27/2019
Last updated
01/06/2022
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