Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 8980 | KY |
NPI | 1740253509 |
---|---|
Provider Name | Dr. Craig B Fowler |
First Address | Lexington, KY 40536-0297 |
Second Address | Lexington, KY 40536-0297 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 06/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100183680 | (05) | KY |