TKB Fowler DO Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20A7881 Issued in CA

Legal business name

TKB FOWLER DO INC

Practice address

6189 La Palma Ave
Buena Park, CA 90620-2858

Phone

(714) 522-2891

Fax

(714) 522-8176

NPI assigned

Feb 12, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Terry KB Fowler, DO

Title

President

Phone

(714) 522-2891

Specialties & licenses 4

Addresses

Other names 1

• Genesis Medical Clinic Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215043200000",
    "number": "1215079892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6189 LA PALMA AVE",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906202858",
            "telephone_number": "714-522-2891",
            "fax_number": "714-522-8176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6189 LA PALMA AVE",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906202858",
            "telephone_number": "714-522-2891",
            "fax_number": "714-522-8176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TKB FOWLER DO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2008-07-03",
        "status": "A",
        "authorized_official_last_name": "FOWLER",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "KB",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-522-2891",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "00AX78810",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A7881",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A7613",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A43569",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Genesis Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Buena Park, CA
• Providers in Buena Park, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.