Individual
DR. THOMAS D FOWLKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
1916 UNIVERSITY AVE, OXFORD, MS 38655-4114
(662) 281-1306
(662) 281-1326
Mailing address
PO BOX 1093, OXFORD, MS 38655-1093
(662) 801-7508
(662) 234-8531
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
13406
MS
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
13406
MS
208D00000X
General Practice Physician
13406
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01508551
—
MS
01
—
5916714
CIGNA PIN
MS
Enumeration date
10/05/2006
Last updated
07/10/2012
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