Healthcare Provider Details

I. General information

NPI: 1225021686
Provider Name (Legal Business Name): LAURIE B FOWLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 CHAPEL HILL RD STE G
COLUMBIA MO
65203-5504
US

IV. Provider business mailing address

PO BOX 852
COLUMBIA MO
65205-0852
US

V. Phone/Fax

Practice location:
  • Phone: 573-234-2600
  • Fax: 573-234-2622
Mailing address:
  • Phone: 573-234-2600
  • Fax: 573-234-2622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD103556
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: