Individual
JONATHAN WILLIAM FOWLKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 W KENT AVE, MISSOULA, MT 59801-6772
(406) 541-3937
(406) 541-3811
Mailing address
700 W KENT AVE, MISSOULA, MT 59801-6772
(406) 541-3277
(406) 541-3811
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
60848
MT
207Y00000X
Otolaryngology Physician
MD-44083
IA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/26/2012
Last updated
06/01/2018
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