Provider Demographics
NPI:1568290906
Name:FOWLER, BRYSON
Entity type:Individual
Prefix:
First Name:BRYSON
Middle Name:
Last Name:FOWLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N HAMPTON RD STE 422
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2391
Mailing Address - Country:US
Mailing Address - Phone:214-326-0677
Mailing Address - Fax:
Practice Address - Street 1:1801 N HAMPTON RD STE 422
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2391
Practice Address - Country:US
Practice Address - Phone:214-326-0677
Practice Address - Fax:214-602-6900
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy