Organization
FOWLER SPORTS MEDICINE AND HEALTH PROMOTION
Active
Other names
Fowler Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT WESLEY FOWLER M.D. (OWNER)
(817) 488-0885
Entity
Organization
Contact information
Practice address
2303 IRA E WOODS AVE, GRAPEVINE, TX 76051-3926
(817) 488-0885
(817) 424-1234
Mailing address
2303 IRA E WOODS AVE, GRAPEVINE, TX 76051-3926
(817) 488-0885
(817) 424-1234
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
H5707
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2903383006
CIGNA
TX
01
—
4490907
AETNA
TX
05
—
8756B7
—
TX
01
—
8G3940
BCBS
TX
Enumeration date
01/11/2008
Last updated
01/11/2008
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