Provider Demographics
NPI:1578547139
Name:KOBRIN, LOWELL EDMUND (PHD MD)
Entity Type:Individual
Prefix:DR
First Name:LOWELL
Middle Name:EDMUND
Last Name:KOBRIN
Suffix:
Gender:M
Credentials:PHD MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-0000
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:541-266-0191
Practice Address - Street 1:1900 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-0000
Practice Address - Country:US
Practice Address - Phone:541-267-5151
Practice Address - Fax:541-266-0191
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD11272208D00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORCB3544OtherRR MEDICARE GROUP NUMBER
ORP00389909OtherRR MEDICARE PTAN NUMBER
ORR0000WFBTVOtherMEDICARE GROUP PIN NUMBER
OR1407812365OtherNBMC NPI NUMBER-GROUP
OR005892Medicaid
OR1407812365OtherNBMC NPI NUMBER-GROUP
OR1407812365OtherNBMC NPI NUMBER-GROUP
ORC94403Medicare UPIN
OR0577260001Medicare NSC