Individual
LARRY JOHN FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610-3003
(352) 265-0238
(352) 265-0437
Mailing address
PO BOX 918025, ORLANDO, FL 32891-8025
(352) 265-0238
(352) 265-0437
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
J4806
TX
207ZC0500X
Cytopathology Physician
J4806
TX
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
J4806
TX
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
ME105199
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001415400
—
FL
01
—
103887901
CSHCN
TX
05
—
103887902
—
TX
Enumeration date
08/24/2006
Last updated
12/17/2009
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