Provider Demographics
NPI:1275519167
Name:MANKIN, LOWELL STEEDE (MD)
Entity Type:Individual
Prefix:
First Name:LOWELL
Middle Name:STEEDE
Last Name:MANKIN
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:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0866
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:972-715-5682
Practice Address - Street 1:6606 LBJ FWY STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6524
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9190207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102490304Medicaid
TX102490306Medicaid
TX102490307Medicaid
TX8EH571OtherBCBS TX
TX050064745OtherRAILROAD MEDICARE
TX102490308Medicaid
TX102490305Medicaid
TX102490303Medicaid
TX84715KOtherBCBS
TX102490301Medicaid
TX102490308Medicaid
G14074Medicare UPIN
TX102490307Medicaid
TX102490304Medicaid
TX89581KMedicare PIN
TX89114KMedicare PIN
TX84715KMedicare PIN