Provider Demographics
NPI:1790749836
Name:LOWTHER, CHRISTOPHER MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:LOWTHER
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 1:802 GERRANS AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-4120
Mailing Address - Country:US
Mailing Address - Phone:307-587-7000
Mailing Address - Fax:307-587-7009
Practice Address - Street 1:802 GERRANS AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4120
Practice Address - Country:US
Practice Address - Phone:307-587-7000
Practice Address - Fax:307-587-7009
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5252A207R00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY113393400Medicaid
WY110198727OtherRAILROAD MEDICARE
WY110880800OtherFEDERAL UNEMPLOYMENT
WY113393400Medicaid
WYW9324Medicare PIN