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NPI Code Detail

MEDICARE: WILLIAM FOWLKES IV MD

MEDICARE: WILLIAM FOWLKES IV MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine PhysicianNC

General Provider Information

NPI Number : 1265592430
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM FOWLKES IV MD
Provider Business Mailing Address
First Line : 861 SW 78TH AVE
Second Line : SUITE # 100B
City : PLANTATION
State : FL
Zip : 33324-3273
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 HOSPITAL DR
Second Line :
City : LOUISBURG
State : NC
Zip : 27549-2256
Country : US
Telephone Number : 919-497-8411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2006
Last Update Date : 07/08/2007

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