Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 695820 | TX |
NPI | 1023340262 |
---|---|
Provider Name | Dr. Christopher Lee Fowler |
First Address | Dallas, TX 75203-1201 |
Second Address | Dallas, TX 75203-1201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2010 |
Last Update Date | 11/02/2010 |