WILEY DOUGLAS FOWLER III (NPI# 1780936278) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780936278 |
| Entity Type | Individual |
| Full Name | WILEY DOUGLAS FOWLER III |
| Credential | PA-C |
| Practice Address |
1127 16th Ave S Jacksonville Beach FL 32250 |
| Mailing Address |
Po Box 45443 Salt Lake City UT 84145-0443 |
| Practice Telephone | 9042477778 |
| Mailing Telephone | 9042021032 |
| Mailing Fax Number | 9043764107 |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2018-12-31 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1127 16th Ave S, Jacksonville Beach, FL 32250 | 9042477778 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508989468 | Wiley Leland Fowler | Obstetrics & Gynecology | 3000 Q Street, Sacramento, CA 95816 | 2007-04-07 |
| Street Address |
1127 16TH AVE S |
| City | JACKSONVILLE BEACH |
| State | FL |
| Zip Code | 32250 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427025790 | Judith Ann Killeen | Nurse Practitioner | 1127 16th Ave S, Jacksonville Beach, FL 32250 | 2006-03-04 |
| 1689189540 | Baptist Primary Care Inc | Family Medicine | 1127 16th Ave S, Jacksonville Beach, FL 32250-3213 | 2017-12-13 |
| 1912161340 | Jose Raphael G Tamayo | Family Medicine | 1127 16th Ave S, Jacksonville Beach, FL 32250-3213 | 2008-07-15 |
| 1508986936 | Mark A Messinese Md Pa | Internal Medicine | 1127 16th Ave S, Jacksonville Beach, FL 32250-3213 | 2007-03-30 |
| 1922021104 | Mark Allen Messinese | Internal Medicine | 1127 16th Ave S, Jacksonville Beach, FL 32250 | 2006-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386129591 | Kelsey Ilene Keimig | Audiologist | 3200 S 3rd Street, Ste 101, Jacksonville, FL 32250 | 2018-10-03 |
| 1225529696 | Turning Tides Eating Disorder Treatment Center, LLC. | Clinic/Center | 4300 Marsh Landings Blvd. #101, Jacksonville Beach, FL 32250 | 2018-05-22 |
| 1528578820 | Dianne Frances Gay | Dental Hygienist | 1144 14th Street North, Jacksonville Beach, FL 32250 | 2017-10-02 |
| 1801324280 | Kailo Nutrition | Dietitian, Registered | 353 B 6th Street South, Jacksonville, FL 32250 | 2017-05-30 |
| 1275985368 | Shankeertha Sundaralingam | Dentist | 3316 3rd St S Ste 101, Jacksonville Beach, FL 32250 | 2016-07-13 |
| 1851777494 | Brooke Worthington Davidson | Audiologist | 1370 13th Ave S Ste 115, Jacksonville Beach, FL 32250 | 2015-08-05 |
| 1689059115 | Jenna Levine | Speech-Language Pathologist | 779 10th Avenue South, Jacksonville Beach, FL 32250 | 2015-07-27 |
| 1790176824 | Olivia Ingram Caswell | Acupuncturist | 2902 Isabella Boulevard, Suite 50, Jacksonville Beach, FL 32250 | 2015-02-11 |
| 1467859033 | Colleen Freeman | Physical Therapist | 1537 Penman Rd, Jacksonville, FL 32250 | 2014-11-26 |
| 1356750012 | Madelyn Jones | Physical Therapist | 1320 Roberts Drive, Jacksonville Beach, FL 32250 | 2014-08-07 |
| Find all providers in zip 32250 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659548949 | Nicolas Charles Condrey | Physician Assistant | 1361 13th Ave S Ste 270, Credentialing Department, Jacksonville Beach, FL 32250-3258 | 2008-05-15 |
| 1972797132 | Elleanor Sapin Swartz | Physician Assistant | 3200 3rd St S, Ste 200, Jacksonville Beach, FL 32250-6097 | 2007-08-30 |
| 1659419299 | George I. Robinson Jr. | Physician Assistant | 1361 13th Ave S, Suite 170a, Jacksonville Beach, FL 32250-3233 | 2007-02-04 |
| 1053329599 | Deborah Lane Ghandour | Physician Assistant | 1361 13th Ave S, Suite 150, Jacksonville Beach, FL 32250-3233 | 2006-08-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255931325 | Jonathan Thomas Nusbaum | Physician Assistant | 26160 Angelica Rd, Punta Gorda, FL 33955-1419 | 2020-10-28 |
| 1235738659 | Kevin Marcus Luks | Physician Assistant | 10701 Santa Fe Dr, Hollywood, FL 33026-4955 | 2020-10-19 |
| 1245839521 | Stephanie Clay | Physician Assistant | 3455 Rose Mallow Loop, Oviedo, FL 32766-6648 | 2020-10-19 |
| 1104423755 | Lou Joseph Schneggenburger | Physician Assistant | 10115 Forest Hill Blvd Ste 100, Wellington, FL 33414-6178 | 2020-10-07 |
| 1235744582 | Stephanie Graham | Physician Assistant | 1053 Bernice Rd, Rockledge, FL 32955-2201 | 2020-09-14 |
| 1790399483 | Shyla Imani Kissoon | Physician Assistant | 4830 Nw 7th St, Plantation, FL 33317-1410 | 2020-09-01 |
| 1770193500 | My Physician Online | Physician Assistant | 9540 Nw 23rd St, Coral Springs, FL 33065-4974 | 2020-08-06 |
| 1225647977 | Robert Drew Singleton | Physician Assistant | 17501 Biscayne Blvd Ste 460, Aventura, FL 33160-4806 | 2020-07-29 |
| 1750990974 | Andrea K Webber | Physician Assistant | 8119 Sw State Rd 200, Ocala, FL 34481-3448 | 2020-07-23 |
| 1851919526 | Kyra Panni | Physician Assistant | 3857 Hartwood Ln, Jacksonville, FL 32216-1486 | 2020-07-09 |
| Find all providers with the same taxonomy | ||||
| City | JACKSONVILLE BEACH |
| Zip Code | 32250 |
Please comment or provide details below to improve the information on WILEY DOUGLAS FOWLER III.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.