Individual
DR. STAR VIVIETTE FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
11750 W 2ND PL, SUITE 365, LAKEWOOD, CO 80228-1575
(720) 321-8280
(720) 321-8281
Mailing address
11750 W 2ND PL, SUITE 365, LAKEWOOD, CO 80228-1575
(720) 321-8280
(720) 321-8281
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
DR.0051309
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
22230025
—
CO
Enumeration date
06/15/2009
Last updated
10/23/2015
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