Provider Demographics
NPI:1356442974
Name:LOWE, GIDEON H III (MD)
Entity Type:Individual
Prefix:
First Name:GIDEON
Middle Name:H
Last Name:LOWE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1711 W TEMPLE ST
Mailing Address - Street 2:SUITE 5600
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-5421
Mailing Address - Country:US
Mailing Address - Phone:213-413-1775
Mailing Address - Fax:213-413-3088
Practice Address - Street 1:1711 W TEMPLE ST
Practice Address - Street 2:SUITE 5600
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-5421
Practice Address - Country:US
Practice Address - Phone:213-413-1775
Practice Address - Fax:213-413-3088
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC33638207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC33638Medicare ID - Type Unspecified
CA00C336380Medicare UPIN