Provider Demographics
NPI:1083933436
Name:LOWE, DAVID-RUSH DOUGLAS (MEDICAL TECHNOLOGIST)
Entity Type:Individual
Prefix:
First Name:DAVID-RUSH
Middle Name:DOUGLAS
Last Name:LOWE
Suffix:
Gender:M
Credentials:MEDICAL TECHNOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 791
Mailing Address - Street 2:506 6TH AVE. W.
Mailing Address - City:MOBRIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57601-0791
Mailing Address - Country:US
Mailing Address - Phone:605-848-0394
Mailing Address - Fax:
Practice Address - Street 1:506 6TH AVE W
Practice Address - Street 2:
Practice Address - City:MOBRIDGE
Practice Address - State:SD
Practice Address - Zip Code:57601-2048
Practice Address - Country:US
Practice Address - Phone:605-848-0394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTN38870246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist