Provider Demographics
NPI:1568447092
Name:LOWE, ISAAC EDWIN (MD)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:EDWIN
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 1:1325 E CHURCH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5915
Mailing Address - Country:US
Mailing Address - Phone:805-346-3456
Mailing Address - Fax:805-346-3454
Practice Address - Street 1:916 N WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832
Practice Address - Country:US
Practice Address - Phone:618-790-7401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55370208600000X
IL036162919208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG553700Medicaid
B003OtherTRICARE
WG55370AMedicare PIN
A52934Medicare UPIN
CAOOG553700Medicaid