Individual
JACKSON MATTHEW FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
225 S GRAND AVE, 1628, IOWA CITY, IA 52242
(319) 335-9847
Mailing address
528 S LUCAS ST, IOWA CITY, IA 52240-5604
(708) 710-2302
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
318957
IA
Other
Enumeration date
10/12/2023
Last updated
10/12/2023
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