Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | A100547 | CA |
NPI | 1508989468 |
---|---|
Provider Name | Dr. Wiley Leland Fowler |
First Address | Rancho Cordova, CA 95670-7956 |
Second Address | Sacramento, CA 95816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2007 |
Last Update Date | 09/10/2013 |