Individual
DR. RICHARD J FOWL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5779 E MAYO BLVD, PHOENIX, AZ 85054-4502
(480) 301-8000
Mailing address
5779 E MAYO BLVD, PHOENIX, AZ 85054-4502
(480) 301-8000
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
23566
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
336421
—
AZ
01
—
770000948
RAILROAD MEDICARE
AZ
01
—
86080015085259A054
TRIWEST
AZ
Enumeration date
12/07/2005
Last updated
07/25/2024
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