Individual
DUSTIN FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
221 JEWELL DR, WACO, TX 76712-6630
(254) 753-1411
Mailing address
221 JEWELL DR, WACO, TX 76712-6630
(254) 753-1411
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
S1399
TX
207R00000X
Internal Medicine Physician
LL37667
SC
208000000X
Pediatrics Physician
LL37667
SC
Other
Enumeration date
06/10/2015
Last updated
07/28/2021
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