Provider Demographics
NPI:1265468961
Name:LOWE, JOHN B (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:LOWE
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 1:9 GOLDPOPPY CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506-9529
Mailing Address - Country:US
Mailing Address - Phone:650-303-4273
Mailing Address - Fax:
Practice Address - Street 1:9 GOLDPOPPY CIR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87506-9529
Practice Address - Country:US
Practice Address - Phone:650-303-4273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-086058207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0127464OtherBCMH
OH1829978OtherUHC
OH000000370606OtherANTHEM
OH4661007OtherAETNA
OH2049723Medicaid
OH000000528771OtherANTHEM
OH363782OtherWELLCARE
OH4661007OtherAETNA
OH1829978OtherUHC
OHP00333038OtherRAILROAD MEDICARE
OHE26111Medicare UPIN
OH2049723Medicaid
OHLO4174571Medicare PIN