MEDICARE: MR. CURTIS B FOWLER PA

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	363AM0700X	Medical Physician Assistant	PA16519	CA

General Provider Information

NPI Number	:	1952597338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CURTIS B FOWLER PA

Provider Business Mailing Address
First Line	:	1600 CREEKSIDE DR
Second Line	:	SUITE 2100
City	:	FOLSOM
State	:	CA
Zip	:	95630-3444
Country	:	US
Telephone Number	:	916-983-2663
Fax Number	:	916-983-0602

Provider Business Practice Location Address
First Line	:	1451 RIVER PARK DR STE 260
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4504
Country	:	US
Telephone Number	:	650-826-2945
Fax Number	:

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

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	03/16/2022

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