Healthcare Provider Details

I. General information

NPI: 1285679100
Provider Name (Legal Business Name): THOMAS W FOWLES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 W MAIN ST UNIT B
MOUNT VERNON KY
40456-2523
US

IV. Provider business mailing address

942 W MAIN ST UNIT B
MOUNT VERNON KY
40456-2523
US

V. Phone/Fax

Practice location:
  • Phone: 606-392-2207
  • Fax: 606-392-2139
Mailing address:
  • Phone: 731-571-9223
  • Fax: 931-901-1239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38140
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: