Provider Demographics
NPI:1083673636
Name:FOWLER, BRIAN ZACH (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ZACH
Last Name:FOWLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 24120
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37933-2120
Mailing Address - Country:US
Mailing Address - Phone:865-803-4321
Mailing Address - Fax:865-988-5658
Practice Address - Street 1:908 W. 4TH NORTH STREET
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3894
Practice Address - Country:US
Practice Address - Phone:423-492-6200
Practice Address - Fax:423-492-6201
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA534462085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000637445OtherANTHEM BCBS
TN1521996Medicaid
KY0665409Medicare PIN