Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Wiley Douglas Fowler III, PA-C

Individual provider Medical Physician Assistant · NPI 1780936278

Wiley Douglas Fowler III, PA-C is a Physician Assistant in Ponte Vedra, Florida. Qualified in 2012, 14 years ago. Practices with Baptist Agewell Physicians Inc, a 21-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Florida.

Years since qualifying
14
Licensed in
FL
In the registry since
2012
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

See every abbreviation used in this directory →

Practice location Address checks out

98 Nocatee Village Dr
Ponte Vedra, FL 32081-6152
Phone: (904) 202-4243
Fax: (904) 390-7415
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA9106930 (FL)
Medical Physician Assistant Taxonomy 363AM0700X · Licence PA9106930 (FL)

Record details

NPI number1780936278
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedOctober 8, 2012
Last updated in NPPESDecember 16, 2025
Certification dateDecember 16, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice Baptist Agewell Physicians Inc — 21 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services