Provider Demographics
NPI:1477532414
Name:LOWTHER, GARY A (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:A
Last Name:LOWTHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 409013
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-9013
Mailing Address - Country:US
Mailing Address - Phone:800-377-8721
Mailing Address - Fax:304-523-2241
Practice Address - Street 1:625 JAMES S. TRIMBLE BLVD.
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-9013
Practice Address - Country:US
Practice Address - Phone:606-789-3511
Practice Address - Fax:606-789-1432
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02689207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000377800OtherBLUECROSS BLUESHIELD
KY64035751Medicaid
WV0047498-000Medicaid
OH2636884Medicaid
OH2636884Medicaid
G52424Medicare UPIN