Provider Demographics
NPI:1508086208
Name:LOWDER, TAD WAYNE (DO)
Entity Type:Individual
Prefix:
First Name:TAD
Middle Name:WAYNE
Last Name:LOWDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 SE 131ST AVE
Mailing Address - Street 2:SUITE 203B
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4004
Mailing Address - Country:US
Mailing Address - Phone:360-254-4402
Mailing Address - Fax:
Practice Address - Street 1:406 SE 131ST AVE
Practice Address - Street 2:SUITE 203 B
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4004
Practice Address - Country:US
Practice Address - Phone:360-254-4402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00002161207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine