Active NPI
Larry John Fowler, MD
- Anatomic Pathology & Clinical Pathology Physician
- Gainesville, FL
National Provider Identifier
1417064403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- ME105199
- Practice address
- 1600 SW Archer Rd
Gainesville, FL 32610-3003 - Phone
- (352) 265-0238
- Fax
- (352) 265-0437
- NPI assigned
- Aug 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | J4806 | TX | |
| Internal Medicine Physician | 207R00000X | J4806 | TX | |
| Cytopathology Physician | 207ZC0500X | J4806 | TX | |
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | ME105199 | FL | Primary |
Addresses
Primary practice location
1600 SW Archer Rd
Gainesville, FL 32610-3003
Mailing address
PO Box 918025
Orlando, FL 32891-8025
Phone (352) 265-0238
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 103887902 | Medicaid | TX | |
| 001415400 | Medicaid | FL | |
| 103887901 | Other | TX | CSHCN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J4806 | TX | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1261008000000",
"number": "1417064403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 918025",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328918025",
"telephone_number": "352-265-0238",
"fax_number": "352-265-0437"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 SW ARCHER RD",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326103003",
"telephone_number": "352-265-0238",
"fax_number": "352-265-0437"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOWLER",
"first_name": "LARRY",
"middle_name": "JOHN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-24",
"last_updated": "2009-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "TX",
"license": "J4806",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "TX",
"license": "J4806",
"primary": false
},
{
"code": "207ZC0500X",
"taxonomy_group": "",
"desc": "Pathology, Cytopathology",
"state": "TX",
"license": "J4806",
"primary": false
},
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "FL",
"license": "ME105199",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "103887902",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001415400",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CSHCN",
"identifier": "103887901",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.