Individual
DR. JUSTIN FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6165 W EMERALD ST, BOISE, ID 83704-8613
(208) 302-3900
(208) 302-3955
Mailing address
3551 ROGER BROOKE DR, FORT SAM HOUSTON, TX 78234-4504
(210) 916-3174
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
207XX0801X
Orthopaedic Trauma Physician
2016027259
MO
207XX0801X
Orthopaedic Trauma Physician
M-13069
ID
207XX0801X
Orthopaedic Trauma Physician
MD2014-0304
NM
207XX0801X
Orthopaedic Trauma Physician
Q6009
TX
2086S0102X
Surgical Critical Care Physician
Primary
M-13069
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1L5640
MEDICARE
TX
01
—
2016027259
MO LICENSE
MO
05
—
390382503
—
TX
01
—
P02601779
MCRR
TX
Enumeration date
08/05/2007
Last updated
12/16/2024
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