Provider Demographics
NPI:1336703933
Name:STOW, EDWIN JAMES
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:JAMES
Last Name:STOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 38TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-2630
Mailing Address - Country:US
Mailing Address - Phone:806-787-4167
Mailing Address - Fax:
Practice Address - Street 1:8602 PEACH AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79404-7777
Practice Address - Country:US
Practice Address - Phone:806-745-1021
Practice Address - Fax:806-748-1726
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141486363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health