MEDICARE: LISA S. FOWLER M.D.

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	207R00000X	Internal Medicine Physician	J4122	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PENDING	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265478408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA S. FOWLER M.D.

Provider Business Mailing Address
First Line	:	2510 CROCKETT DR
Second Line	:	STE A
City	:	BROWNWOOD
State	:	TX
Zip	:	76801-5928
Country	:	US
Telephone Number	:	325-646-9956
Fax Number	:	325-641-1010

Provider Business Practice Location Address
First Line	:	2510 CROCKETT DR
Second Line	:	STE A
City	:	BROWNWOOD
State	:	TX
Zip	:	76801-5928
Country	:	US
Telephone Number	:	325-646-9956
Fax Number	:	325-641-1010

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	10/30/2018

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