Healthcare Provider Details

I. General information

NPI: 1619616505
Provider Name (Legal Business Name): ALLERGY AND ASTHMA OF PROSPER AND CELINA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 W FRONTIER PARKWAY SUITE 400
PROSPER TX
75078
US

IV. Provider business mailing address

1640 W FRONTIER PKWY STE 130
PROSPER TX
75078-3197
US

V. Phone/Fax

Practice location:
  • Phone: 469-757-2468
  • Fax: 785-414-5368
Mailing address:
  • Phone: 469-757-2468
  • Fax: 469-519-6974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS MOYLE FOWLER
Title or Position: OFFICER
Credential: MD
Phone: 469-757-2468