Provider Demographics
NPI:1699246884
Name:FOWLER, AARON (LAT)
Entity type:Individual
Prefix:MR
First Name:AARON
Middle Name:
Last Name:FOWLER
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 FLANAGAN FARM DR
Mailing Address - Street 2:
Mailing Address - City:NORTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-1971
Mailing Address - Country:US
Mailing Address - Phone:903-253-1673
Mailing Address - Fax:
Practice Address - Street 1:1401 FLANAGAN FARM DR
Practice Address - Street 2:
Practice Address - City:NORTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76226-1971
Practice Address - Country:US
Practice Address - Phone:903-253-1673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT3007207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine