Individual
JOSEPH L FOWLER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
500 SW RAMSEY AVE, GRANTS PASS, OR 97527-5543
(541) 472-7267
Mailing address
2620 E BARNETT RD STE H, MEDFORD, OR 97504-8383
(541) 789-4281
(541) 789-5538
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
201408269CRNA
OR
367500000X
Certified Registered Nurse Anesthetist
63750
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1811079528
WELLMARK BLUE CROSS BLUE SHIELD
—
05
—
1811079528
—
IA
01
—
P00656985
RR MEDICARE
IA
Enumeration date
10/20/2006
Last updated
12/11/2014
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