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1265995872 NPI number — JOSHUA DAVIS FOWLER

NPI Number: 1265995872
Health Care Provider/Practitioner: JOSHUA DAVIS FOWLER

Information about “1265995872” NPI (JOSHUA DAVIS FOWLER) exists in 1265995872 in HTML format HTML  |  1265995872 in plain Text format TXT  |  1265995872 in PDF (Portable Document Format) PDF  |  1265995872 in an XML format XML  formats.

NPI Number : 1265995872 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265995872",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FOWLER",
    "FirstName": "JOSHUA",
    "MiddleName": "DAVIS",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "120 TUXFORD RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "STARKVILLE",
    "MailingAddressStateName": "MS",
    "MailingAddressPostalCode": "39759-4061",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "662-645-5674",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "100 BRANDON RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "STARKVILLE",
    "PracticeLocationAddressStateName": "MS",
    "PracticeLocationAddressPostalCode": "39759-2571",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "601-354-4836",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/10/2019",
    "LastUpdateDate": "06/27/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "33101",
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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