Healthcare Provider Details

I. General information

NPI: 1881045243
Provider Name (Legal Business Name): ALYSSA MOWRER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA LAWLER

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 PENNSYLVANIA AVE STE 690
FORT WORTH TX
76104-2133
US

IV. Provider business mailing address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 817-761-7740
  • Fax:
Mailing address:
  • Phone: 414-266-6550
  • Fax: 414-266-6579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number75370
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberU4277
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: