Provider Demographics
NPI:1518691765
Name:LOWREY, JASON MONTGOMERY
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MONTGOMERY
Last Name:LOWREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 JAMES ST NE
Mailing Address - Street 2:
Mailing Address - City:CHATFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55923-1751
Mailing Address - Country:US
Mailing Address - Phone:507-993-7961
Mailing Address - Fax:
Practice Address - Street 1:1820 PINE ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-3750
Practice Address - Country:US
Practice Address - Phone:608-785-6515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program