MEDICARE: TKB FOWLER DO INC

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	00AX78810	CA
2	207Q00000X	Family Medicine Physician	20A7613	CA
3	207Q00000X	Family Medicine Physician	A43569	CA
4	207Q00000X	Family Medicine Physician	20A7881	CA

General Provider Information

NPI Number	:	1215079892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TKB FOWLER DO INC

Provider Business Mailing Address
First Line	:	6189 LA PALMA AVE
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90620-2858
Country	:	US
Telephone Number	:	714-522-2891
Fax Number	:	714-522-8176

Provider Business Practice Location Address
First Line	:	6189 LA PALMA AVE
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90620-2858
Country	:	US
Telephone Number	:	714-522-2891
Fax Number	:	714-522-8176

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TERRY KB FOWLER
Credential	:	DO
Telephone Number	:	714-522-2891

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	07/03/2008

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Directions to “TKB FOWLER DO INC ” Practice Location

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