Individual
JOHN RICHARD FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
5353 GAMBLE DR, SUITE 108, ST LOUIS PARK, MN 55416-1509
(952) 545-8833
Mailing address
5353 GAMBLE DRIVE, STE 108, ST LOUIS PARK, MA 55416
(952) 545-8833
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP1765
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04757F0
BCBS
MN
01
—
1581524
MEDICA
MN
01
—
V41164257704871
HEALTH PARTNERS
—
Enumeration date
10/12/2006
Last updated
07/08/2007
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