MEDICARE: JOHN RICHARD FOWLER PHD

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
1	103TC0700X	Clinical Psychologist	LP1765	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V41164257704871	OTHER		HEALTH PARTNERS
2	04757F0	OTHER	MN	BCBS
3	1581524	OTHER	MN	MEDICA

General Provider Information

NPI Number	:	1588753941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN RICHARD FOWLER PHD

Provider Business Mailing Address
First Line	:	5353 GAMBLE DRIVE
Second Line	:	STE 108
City	:	ST LOUIS PARK
State	:	MA
Zip	:	55416
Country	:	US
Telephone Number	:	952-545-8833
Fax Number	:

Provider Business Practice Location Address
First Line	:	5353 GAMBLE DR
Second Line	:	SUITE 108
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1509
Country	:	US
Telephone Number	:	952-545-8833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

Similar Medicare Providers

1376524538 — DR. JORDAN LYNN HART PH.D., L.P.
Practice Location Address:

5353 GAMBLE DR , SUITE 110
ST LOUIS PARK, MN
55416-1509

Practice Phone: 763-432-4071
Practice Fax: 763-432-4073

1841347085 — MICHAEL E. BERGER PA
Practice Location Address:

5353 GAMBLE DR , SUITE 160
ST LOUIS PARK, MN
55416-1509

Practice Phone: 952-929-2276
Practice Fax: 952-929-8576

1477709392 — FOWLER PSYCHOLOGICAL SERVICES, INC.
Practice Location Address:

5353 GAMBLE DR , 108
ST LOUIS PARK, MN
55416-1509

Practice Phone: 952-545-8833
Practice Fax: 952-224-2299

1144772427 — LAURA LYNN DERING M.S.
Practice Location Address:

5353 GAMBLE DR , SUITE 110
ST LOUIS PARK, MN
55416-1509

Practice Phone: 612-747-3945
Practice Fax:

1841957305 — OSTARA INITIATIVE
Practice Location Address:

5353 GAMBLE DR
ST LOUIS PARK, MN
55416-1509

Practice Phone: 612-382-3095
Practice Fax:

1508066762 — JUDITH C. PARA R.N.
Practice Location Address:

1533 LOUIS KOSSUTH AVE
BOHEMIA, NY
11716-1509

Practice Phone: 631-589-3998
Practice Fax:

Directions to “ JOHN RICHARD FOWLER PHD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.