Basic Information
| Provider Information | |||||||||
| NPI: | 1619927126 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOWLER | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 915 13TH AVE N | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | IA | ||||||||
| PostalCode: | 527325067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5632432511 | ||||||||
| FaxNumber: | 5632436081 | ||||||||
| Practice Location | |||||||||
| Address1: | 1021 11TH ST | ||||||||
| Address2: | |||||||||
| City: | DE WITT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 527421209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5636599294 | ||||||||
| FaxNumber: | 5636598104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 03/15/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 30991 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 43636 | 01 | IA | WELLMARK BC/BS | OTHER | 8946 | 01 | MIDLANDS CHOICE | OTHER | 7142752 | 05 | IA | MEDICAID | 072177 | 01 | HEALTH ALLIANCE | OTHER | 35987 | 01 | IOWA HEALTH SOLUTIONS | OTHER | IA 0191 | 01 | JOHN DEERE HEALTH | OTHER |