Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD103556 | MO |
NPI | 1225021686 |
---|---|
Provider Name | Laurie B Fowler |
First Address | Columbia, MO 65205-0852 |
Second Address | Columbia, MO 65203-5504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 08/07/2007 |