Healthcare Provider Details

I. General information

NPI: 1639112451
Provider Name (Legal Business Name): JEFFREY M. FOWLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 RIDGE MILL DR
HILLIARD OH
43026-7752
US

IV. Provider business mailing address

3651 RIDGE MILL DR
HILLIARD OH
43026-7752
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-3873
  • Fax: 614-293-3078
Mailing address:
  • Phone: 614-293-3873
  • Fax: 614-266-8772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number01086901A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number35056039
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: