Provider Demographics
NPI:1720184716
Name:EAST BAY PULMONARY MEDICAL GROUP
Entity Type:Organization
Organization Name:EAST BAY PULMONARY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOWERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-814-4089
Mailing Address - Street 1:2070 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4320
Mailing Address - Country:US
Mailing Address - Phone:510-814-4089
Mailing Address - Fax:510-521-4187
Practice Address - Street 1:2070 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4320
Practice Address - Country:US
Practice Address - Phone:510-814-4089
Practice Address - Fax:510-521-4187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0007320Medicaid
CAGR0007320Medicaid
ZZZ88061ZMedicare PIN