Provider Demographics
NPI:1083614960
Name:LOWDER, CATHERINE L (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:L
Last Name:LOWDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12700 SOUTHFORK RD
Mailing Address - Street 2:STE 280
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3201
Mailing Address - Country:US
Mailing Address - Phone:314-525-4990
Mailing Address - Fax:314-525-4926
Practice Address - Street 1:13303 TESSON FERRY RD STE 45
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-4062
Practice Address - Country:US
Practice Address - Phone:314-748-5917
Practice Address - Fax:314-748-5919
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111722207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205015902Medicaid
MOF20034Medicare UPIN
MO205015902Medicaid