Provider Demographics
NPI:1437596483
Name:JIM D LOWERY MD PLLC
Entity Type:Organization
Organization Name:JIM D LOWERY MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATRINKA
Authorized Official - Middle Name:
Authorized Official - Last Name:UNDERKOFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-842-4435
Mailing Address - Street 1:1117 NW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-4401
Mailing Address - Country:US
Mailing Address - Phone:405-842-4435
Mailing Address - Fax:405-842-2846
Practice Address - Street 1:1117 NW 50TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4401
Practice Address - Country:US
Practice Address - Phone:405-842-4435
Practice Address - Fax:405-842-2846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1491402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100130840AMedicaid
OK100130840AMedicaid