Organization
FOWLER SPORTS MEDICINE AND HEALTH PROMOTION
Active
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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