Healthcare Provider Details

I. General information

NPI: 1265438972
Provider Name (Legal Business Name): EMILY FOWLER OMURA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MS. MARTHA EMILY FOWLER

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 INDEPENDENCE DR
BIRMINGHAM AL
35209-5710
US

IV. Provider business mailing address

3550 INDEPENDENCE DR
BIRMINGHAM AL
35209-5710
US

V. Phone/Fax

Practice location:
  • Phone: 205-949-2806
  • Fax: 205-949-2875
Mailing address:
  • Phone: 205-949-2806
  • Fax: 205-949-2875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number4088
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberME89014
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: