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Individual

DR. WYATT CHARLES FOWLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
125 QUEENS RD STE 430, CHARLOTTE, NC 28204-3215
(980) 302-6300
(980) 302-6305
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
38940
NC
2086X0206X
Surgical Oncology Physician
38940
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10272
BLUE CROSS AND BLUE SHIEL
NC
05
8910272
NC
05
N38940
SC
Enumeration date
09/20/2006
Last updated
08/13/2021
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