Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 15728 | SC |
NPI | 1003800426 |
---|---|
Provider Name | Mr. William Edward Fowler |
First Address | Greenwood, SC 29646 |
Second Address | Hodges, SC 29653 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 09/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E99177 | (02) | SC |
L11299 | (05) | SC |