Provider Demographics
NPI:1023006277
Name:FAGRE, JON LOWELL (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:LOWELL
Last Name:FAGRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 N SWING
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-9472
Mailing Address - Country:US
Mailing Address - Phone:515-291-4353
Mailing Address - Fax:
Practice Address - Street 1:5601 N SWING
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-9472
Practice Address - Country:US
Practice Address - Phone:515-291-4353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25021207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA03935Medicare UPIN