Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 481 | NC |
NPI | 1275549479 |
---|---|
Provider Name | Dr. Stacy Fowler |
First Address | Mebane, NC 27302-7116 |
Second Address | Mebane, NC 27302-7116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 02/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
081AJ | BLUE CROSS (01) | NC |
11453384 | FIRST HEALTH (01) | NC |
89081AJ | (05) | NC |
U96048 | (02) |