Provider Demographics
NPI:1164424354
Name:LOWE, LEONARD ALEXANDER JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:ALEXANDER
Last Name:LOWE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LEONARD
Other - Middle Name:ALEXANDER
Other - Last Name:LOWE
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:JD
Mailing Address - Street 1:1010 A ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-2021
Mailing Address - Country:US
Mailing Address - Phone:970-313-0400
Mailing Address - Fax:970-313-0404
Practice Address - Street 1:2930 11TH AVE
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:CO
Practice Address - Zip Code:80620-1011
Practice Address - Country:US
Practice Address - Phone:970-350-4606
Practice Address - Fax:970-350-4692
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44762207P00000X
CO54200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038406200Medicaid
FL94529OtherBCBS
FL038406200Medicaid
FL94529CMedicare ID - Type Unspecified