Healthcare Provider Details

I. General information

NPI: 1679733042
Provider Name (Legal Business Name): MALINI FOWLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. MALINI PATEL

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2632 BROADWAY ST STE 300
SAN ANTONIO TX
78215-1137
US

IV. Provider business mailing address

8825 BEE CAVES RD STE 100
AUSTIN TX
78746-4721
US

V. Phone/Fax

Practice location:
  • Phone: 210-802-0085
  • Fax: 210-775-0082
Mailing address:
  • Phone: 512-328-3376
  • Fax: 512-666-3767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberN7473
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: