Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | DC27430 | CA |
Y | 213ER0200X | Radiology | DC27430 | CA |
NPI | 1225061112 |
---|---|
Provider Name | Dr. David Andrew Fowler |
First Address | Tukwila, WA 98168-3340 |
Second Address | Tukwila, WA 98168-3340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 13/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0274300 | BLUE SHIELD (01) | CA |
U91445 | (02) | CA |