Provider Demographics
NPI:1538161583
Name:FOWLER, JOSEPH F JR (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:F
Last Name:FOWLER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:866-630-9882
Mailing Address - Fax:920-682-5810
Practice Address - Street 1:501 S 2ND ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2862
Practice Address - Country:US
Practice Address - Phone:502-583-7546
Practice Address - Fax:502-589-3429
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1030824207N00000X
KY21622207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64216229Medicaid
KY0381301Medicare PIN
C69198Medicare UPIN
IN100194960BMedicaid
070006869OtherRR MEDICARE
IN330630Medicare PIN