1356406599 NPI number — PHILLIP LOWE MD

Table of content: PHILLIP LOWE MD (NPI 1356406599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356406599 NPI number — PHILLIP LOWE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOWE
Provider First Name:
PHILLIP
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356406599
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12890
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
83002-2890
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-733-7460
Provider Business Mailing Address Fax Number:
307-733-7482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 E BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
83001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-733-7460
Provider Business Practice Location Address Fax Number:
307-733-7482
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  6215A , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2088P0231X , with the licence number: 6215A , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 806233600 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 806684400 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 118827500 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114954700 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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