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1144294570

NPI Code Detail

MEDICARE: DR. ROGER N FOWLER MD

MEDICARE: DR. ROGER N FOWLER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G1009	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	752616977028	OTHER	TX	TRICARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	8S3318	OTHER	TX	BCBS OF TEXAS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	75-2616977-066	OTHER	TX	TRICARE

General Provider Information

NPI Number	:	1144294570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER N FOWLER MD

Provider Business Mailing Address
First Line	:	PO BOX 846098
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-6098
Country	:	US
Telephone Number	:	903-324-6450
Fax Number	:

Provider Business Practice Location Address
First Line	:	3202 S MAIN ST
Second Line	:
City	:	LINDALE
State	:	TX
Zip	:	75771-7727
Country	:	US
Telephone Number	:	903-882-0991
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	04/03/2015

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Directions to “ DR. ROGER N FOWLER MD” Practice Location

Language	Start Address	Practice Location

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