Provider Demographics
NPI:1417336116
Name:LOW, MATTHEW LAURITZ (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LAURITZ
Last Name:LOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 W IRONWOOD DR STE 350
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4487
Mailing Address - Country:US
Mailing Address - Phone:208-625-5222
Mailing Address - Fax:208-625-5223
Practice Address - Street 1:700 W IRONWOOD DR STE 350
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4487
Practice Address - Country:US
Practice Address - Phone:208-625-5222
Practice Address - Fax:208-625-5223
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCLL38230208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery