Organization
FOWLER MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAYMOND PETRIE MD (PHYSICIAN/OWNER)
(765) 884-1330
Entity
Organization
Contact information
Practice address
801 E 5TH ST, FOWLER, IN 47944-1568
(765) 884-1330
Mailing address
801 E 5TH ST, FOWLER, IN 47944-1568
(765) 884-1330
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
0131474
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100142830
—
IN
05
—
200085460
—
IN
01
—
390690
MEDICARE
IN
Enumeration date
05/09/2008
Last updated
05/09/2008
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