Provider Demographics
NPI:1316923584
Name:FOWLER, RICHARD F (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:F
Last Name:FOWLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 E MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-8953
Mailing Address - Country:US
Mailing Address - Phone:480-830-4164
Mailing Address - Fax:480-830-5009
Practice Address - Street 1:6315 E MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8953
Practice Address - Country:US
Practice Address - Phone:480-830-4164
Practice Address - Fax:480-830-5009
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16349207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0250000OtherBLUE CROSS BLUE SHEILD
AZWCLDB01Medicare ID - Type Unspecified
AZD36861Medicare UPIN