Provider Demographics
NPI:1790763969
Name:HARVEY, LOWELL (MD)
Entity Type:Individual
Prefix:
First Name:LOWELL
Middle Name:
Last Name:HARVEY
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 1:1208 BROOK AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-5602
Mailing Address - Country:US
Mailing Address - Phone:940-322-4480
Mailing Address - Fax:940-322-8420
Practice Address - Street 1:1208 BROOK AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5602
Practice Address - Country:US
Practice Address - Phone:940-322-4480
Practice Address - Fax:940-322-8420
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4853207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX613202Medicare PIN