Individual
MARJORIE REES FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
Mailing address
1541 KINGS HWY, ATTN: PAYOR CREDENTIALING, SHREVEPORT, LA 71103-4228
Taxonomy
Speciality
Code
Description
License number
State
207ZN0500X
Neuropathology Physician
MD.010888
LA
207ZP0101X
Anatomic Pathology Physician
Primary
MD.010888
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1436593
—
LA
01
—
270219YH54
MEDICARE - PTAN
LA
Enumeration date
07/10/2006
Last updated
11/13/2024
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