MEDICARE: DR. ELIZABETH M FOWLER EDD

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	103TC0700X	Clinical Psychologist	23681	TX

General Provider Information

NPI Number	:	1932253325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH M FOWLER EDD

Provider Business Mailing Address
First Line	:	1020 HOLCOMBE BLVD
Second Line	:	1304
City	:	HOUSTON
State	:	TX
Zip	:	77030-2210
Country	:	US
Telephone Number	:	713-795-5354
Fax Number	:	713-795-4729

Provider Business Practice Location Address
First Line	:	1020 HOLCOMBE BLVD
Second Line	:	1304
City	:	HOUSTON
State	:	TX
Zip	:	77030-2210
Country	:	US
Telephone Number	:	713-795-5354
Fax Number	:	713-795-4729

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	04/01/2008

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