Individual
DR. TERRY KB FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4745 N 7TH ST, SUITE 140, PHOENIX, AZ 85014-3665
(602) 735-3761
(602) 778-3331
Mailing address
3344 S ROCKWELL ST, GILBERT, AZ 85297-2148
(480) 398-7791
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
006092
AZ
207Q00000X
Family Medicine Physician
20A7881
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006092
ARIZONA MEDICAL LICENSE
AZ
05
—
00AX78810
—
CA
Enumeration date
08/10/2005
Last updated
01/07/2015
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