Provider Demographics
NPI: | 1518057298 |
---|---|
Name: | LOWES, BRIAN (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | BRIAN |
Middle Name: | |
Last Name: | LOWES |
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: | 988102 NEBRASKA MEDICAL CTR |
Mailing Address - Street 2: | |
Mailing Address - City: | OMAHA |
Mailing Address - State: | NE |
Mailing Address - Zip Code: | 68198-8102 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | EMILE @ 42ND ST |
Practice Address - Street 2: | |
Practice Address - City: | OMAHA |
Practice Address - State: | NE |
Practice Address - Zip Code: | 68198-4507 |
Practice Address - Country: | US |
Practice Address - Phone: | 402-559-8888 |
Practice Address - Fax: | 402-559-3060 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-10-13 |
Last Update Date: | 2018-03-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | 31200 | 207RI0011X |
NE | 26429 | 207RA0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RA0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Advanced Heart Failure and Transplant Cardiology |
No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CO | 01312008 | Medicaid | |
CO | 01312008 | Medicaid | |
CO | F23375 | Medicare UPIN |