Provider Demographics
NPI:1790972321
Name:LOWELL, JON DENNIS (PA-C)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:DENNIS
Last Name:LOWELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 SW. INDIAN MARY COURT
Mailing Address - Street 2:
Mailing Address - City:TROUTDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97060
Mailing Address - Country:US
Mailing Address - Phone:503-465-6591
Mailing Address - Fax:
Practice Address - Street 1:2304 SW INDIAN MARY CT
Practice Address - Street 2:
Practice Address - City:TROUTDALE
Practice Address - State:OR
Practice Address - Zip Code:97060-1769
Practice Address - Country:US
Practice Address - Phone:503-465-6591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005262363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORPA 00215OtherOREGON STATE BOARD OF MEDICAL EXAMINERS
WAPA10005262OtherSTATE OF WA DEPT HEALTH