Provider Demographics
NPI:1023377637
Name:LOWERY, MARY A (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:LOWERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1410
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93448-1410
Mailing Address - Country:US
Mailing Address - Phone:805-489-2205
Mailing Address - Fax:805-489-2206
Practice Address - Street 1:931 OAK PARK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3403
Practice Address - Country:US
Practice Address - Phone:805-474-2600
Practice Address - Fax:805-474-2607
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH7181207R00000X
CAC51566207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine