Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 40875 | TN |
NPI | 1669432761 |
---|---|
Provider Name | Dr. Carol L Fowler |
First Address | Knoxville, TN 37916 |
Second Address | Knoxville, TN 37916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40875 | MEDICAL LICENSE (01) | TN |
BF2876324 | DEA (01) | |
E92930 | (02) |