Provider Demographics
NPI:1508829276
Name:LOWRY, RICHARD LEE (OPA-C)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LEE
Last Name:LOWRY
Suffix:
Gender:M
Credentials:OPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 PREMIER DR
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6076
Mailing Address - Country:US
Mailing Address - Phone:507-386-6600
Mailing Address - Fax:507-625-5971
Practice Address - Street 1:1431 PREMIER DR
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6076
Practice Address - Country:US
Practice Address - Phone:507-386-6600
Practice Address - Fax:507-625-5971
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8837363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN106T7LOOtherBCBS OF MN
MN430612100Medicaid
MN143269C572OtherUCARE MN
MN983181030732OtherPREFERRED ONE
MNHP47714OtherHEALTH PARTNERS