Provider Demographics
NPI:1215992359
Name:FOWLER, JEFFREY V (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:V
Last Name:FOWLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:MS 315010
Mailing Address - Street 2:PO BOX 3947
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3947
Mailing Address - Country:US
Mailing Address - Phone:425-467-3655
Mailing Address - Fax:425-635-6388
Practice Address - Street 1:1135-116TH AVENUE NE
Practice Address - Street 2:SUITE 600
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-454-2656
Practice Address - Fax:425-455-2620
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00039660207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0209220OtherL & I
WA8431124Medicaid
WAI47294Medicare UPIN
WAG8801204Medicare PIN