MEDICARE: WILLIAM E FOWLER

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	103TC2200X	Clinical Child & Adolescent Psychologist	665	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760647663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM E FOWLER

Provider Business Mailing Address
First Line	:	309 CRYSTAL ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70124-2619
Country	:	US
Telephone Number	:	985-781-0548
Fax Number	:	985-781-4319

Provider Business Practice Location Address
First Line	:	309 CRYSTAL ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70124-2619
Country	:	US
Telephone Number	:	985-781-0548
Fax Number	:	985-781-4319

Authorized Official
Title or Position	:	OWNER
Name	:	MR. WILLIAM E FOWLER
Credential	:	PHD
Telephone Number	:	985-781-0548

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	07/21/2008

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