Healthcare Provider Details

I. General information

NPI: 1881857993
Provider Name (Legal Business Name): STEPHEN DERRICK FOWLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10452 SILVERDALE WAY NW
SILVERDALE WA
98383-9460
US

IV. Provider business mailing address

PO BOX 71
INDIANOLA WA
98342-0071
US

V. Phone/Fax

Practice location:
  • Phone: 360-307-7300
  • Fax: 877-777-9902
Mailing address:
  • Phone: 502-296-8921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD60147300
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: