Individual
DEBORAH LEA FOWLER DIXON BROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
301 EDWARDSVILLE ROAD, TROY, IL 62294
(618) 667-7057
(618) 667-8131
Mailing address
301 EDWARDSVILLE ROAD, TROY, IL 62294
(618) 667-7057
(618) 667-8131
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036901572
IL
208M00000X
Hospitalist Physician
036091572
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036091572
—
IL
Enumeration date
06/03/2006
Last updated
01/04/2025
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