Provider Demographics
NPI:1639348980
Name:LOWDON, JACK (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:LOWDON
Suffix:
Gender:M
Credentials:MD
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Other - Middle Name:
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Mailing Address - Street 1:1821 OLD DONATION PKWY
Mailing Address - Street 2:SUITE 9
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3033
Mailing Address - Country:US
Mailing Address - Phone:757-481-1175
Mailing Address - Fax:757-481-5081
Practice Address - Street 1:1821 OLD DONATION PKWY
Practice Address - Street 2:SUITE 9
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3033
Practice Address - Country:US
Practice Address - Phone:757-481-1175
Practice Address - Fax:757-481-5081
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA01010386572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology