Provider Demographics
NPI:1497851059
Name:LOWREY, TIMOTHY D (CRNA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:D
Last Name:LOWREY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660685
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35266-0685
Mailing Address - Country:US
Mailing Address - Phone:205-979-5882
Mailing Address - Fax:205-979-1248
Practice Address - Street 1:314 S 5TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-4224
Practice Address - Country:US
Practice Address - Phone:256-547-9500
Practice Address - Fax:256-547-3039
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-044923367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51511219OtherBCBS OF AL
AL051511219Medicaid
AL430075311OtherRR MEDICARE
AL51511219OtherBCBS OF AL
AL051511219Medicare ID - Type UnspecifiedMEDICARE