Individual
CODY FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
3345 POTOMAC WAY, IDAHO FALLS, ID 83404-4978
(208) 552-7572
(208) 552-7312
Mailing address
PO BOX 277381, ATLANTA, GA 30384-7381
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA-1326
ID
Other
Enumeration date
11/19/2015
Last updated
02/08/2022
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