Provider Demographics
NPI:1417926809
Name:LOWERY, BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:LOWERY
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 1:1919 S WHEELING AVE
Mailing Address - Street 2:LL 100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5638
Mailing Address - Country:US
Mailing Address - Phone:918-748-7890
Mailing Address - Fax:918-293-3137
Practice Address - Street 1:1919 S WHEELING AVE
Practice Address - Street 2:LL 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5638
Practice Address - Country:US
Practice Address - Phone:918-748-7890
Practice Address - Fax:918-293-3137
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE69339Medicare UPIN