Provider Demographics
NPI:1558658237
Name:LOWE, GARRETT C (MD)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:C
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:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 N CANYON RD STE D
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4678
Practice Address - Country:US
Practice Address - Phone:801-373-3300
Practice Address - Fax:801-354-7900
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105604207N00000X
MN54498207N00000X
UT9342244-1205207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP01147451OtherMEDICARE RAILROAD
MNENROLLEDMedicaid
MN070000944Medicare PIN