Provider Demographics
NPI:1508860123
Name:LOWE, TERRY R (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:R
Last Name:LOWE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MILLSAPS DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1347
Mailing Address - Country:US
Mailing Address - Phone:601-261-5710
Mailing Address - Fax:601-268-5058
Practice Address - Street 1:110 MILLSAPS DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1347
Practice Address - Country:US
Practice Address - Phone:601-261-5710
Practice Address - Fax:601-268-5058
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12857207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSE50742Medicare UPIN
MS00017841Medicare ID - Type Unspecified