Individual provider Active NPI

Robert Fowler, M.D.

  • Specialist
  • Grapevine, TX
National Provider Identifier
1366514259
Registry record updated Dec 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
H5707 Issued in TX
Practice address
2303 Ira E Woods Ave
Grapevine, TX 76051-3926
Phone
(817) 488-0885
Fax
(817) 424-1234
NPI assigned
Nov 15, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X H5707 TX Primary

Addresses

Primary practice location

2303 Ira E Woods Ave
Grapevine, TX 76051-3926

Mailing address

2303 Ira E Woods Ave
Grapevine, TX 76051-3926
Phone (817) 488-0885

Other identifiers 2

IdentifierTypeStateIssuer
3223361OtherTXBLUE LINK
8G3940OtherTXBCBS PROVIDER NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260611004652 TX Order and Referring Only - Family PracticePractitioner - Family PracticePractitioner - Sports Medicine 1557347697

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
H5707TXMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Las Colinas Orthopedic Surgery and Sports Medicine P.a. Specialist Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197417600000",
    "number": "1366514259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2303 IRA E WOODS AVE",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760513926",
            "telephone_number": "817-488-0885",
            "fax_number": "817-424-1234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2303 IRA E WOODS AVE",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760513926",
            "telephone_number": "817-488-0885",
            "fax_number": "817-424-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOWLER",
        "first_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2007-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "H5707",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE LINK",
            "identifier": "3223361",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "8G3940",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grapevine, TX

Sources for this page

Verify at the official NPI Registry.