Basic Information
| Provider Information | |||||||||
| NPI: | 1417959925 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOWLER | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | CURT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1507 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | GATESVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765281024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2548658251 | ||||||||
| FaxNumber: | 2542486306 | ||||||||
| Practice Location | |||||||||
| Address1: | 2027 S 61ST ST STE 109 | ||||||||
| Address2: | |||||||||
| City: | TEMPLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765046856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542950732 | ||||||||
| FaxNumber: | 2546933141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2005 | ||||||||
| LastUpdateDate: | 05/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101237822 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | P4166 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
No ID Information.