Provider Demographics
NPI:1912991514
Name:FOWLER, JAMES B (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:FOWLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1501 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2720
Mailing Address - Country:US
Mailing Address - Phone:719-546-3937
Mailing Address - Fax:719-546-3940
Practice Address - Street 1:1501 COURT ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2720
Practice Address - Country:US
Practice Address - Phone:719-546-3937
Practice Address - Fax:719-546-3940
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO25573207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO841168625002OtherROCKY MOUNTAIN HMO
CO1013121987OtherOPTICAL NPI
CO1316087117OtherCENTER FOR EYE CORP-NPI
CO3050-1OtherBC/BS PROVIDER
01255736OtherLOOMIS COMPANY
CO01255736Medicaid
CO180024299OtherRAILROAD MEDICARE
CO0574778OtherONE HEALTH COLO
SC0409960001OtherPALMENTO MEDICARE
COD24657Medicare UPIN
COC462398Medicare PIN
CO1316087117OtherCENTER FOR EYE CORP-NPI