Healthcare Provider Details

I. General information

NPI: 1043339880
Provider Name (Legal Business Name): W.R. FOWLER, M.D.,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3185 N LESLIE RD
SILVER CITY NM
88061-7211
US

IV. Provider business mailing address

3185 N LESLIE RD
SILVER CITY NM
88061-7211
US

V. Phone/Fax

Practice location:
  • Phone: 505-388-3393
  • Fax: 505-388-2696
Mailing address:
  • Phone: 505-388-3393
  • Fax: 505-388-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LE ANN ROBINSON
Title or Position: CONSULTANT
Credential: R.N.
Phone: 505-388-3393