Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 8800 | AL |
NPI | 1174580062 |
---|---|
Provider Name | Dr. Lewis Jeffers Fowlkes |
First Address | Birmingham, AL 35205-1620 |
Second Address | Birmingham, AL 35205-1620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 27/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
28978 | (05) | AL |
51028977 | BCBS (01) | AL |
C74750 | (02) | AL |