Healthcare Provider Details

I. General information

NPI: 1619927126
Provider Name (Legal Business Name): STEVEN C FOWLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 11TH ST
DE WITT IA
52742-1209
US

IV. Provider business mailing address

915 13TH AVE N
CLINTON IA
52732-5067
US

V. Phone/Fax

Practice location:
  • Phone: 563-659-9294
  • Fax: 563-659-8104
Mailing address:
  • Phone: 563-243-2511
  • Fax: 563-243-6081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30991
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: