Healthcare Provider Details

I. General information

NPI: 1508989468
Provider Name (Legal Business Name): WILEY LELAND FOWLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2007
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 MEDICAL PLAZA DR STE 300
ROSEVILLE CA
95661-3107
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 916-782-5106
  • Fax: 916-878-4941
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberA100547
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: