Individual
JASON FOWLKES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
809 DAVIS ST, STE 1, BLACKSBURG, VA 24060-7013
(540) 961-1590
Mailing address
1055 GREEN RIDGE RD, CHRISTIANSBURG, VA 24073
(540) 798-8887
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0116016565
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356534952
—
VA
Enumeration date
08/27/2007
Last updated
01/19/2010
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