Provider Demographics
NPI:1821066036
Name:LOWERY, JIM D (MD)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:D
Last Name:LOWERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:801 N AIR DEPOT BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110
Mailing Address - Country:US
Mailing Address - Phone:405-733-9516
Mailing Address - Fax:405-733-8853
Practice Address - Street 1:801 N AIR DEPOT BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110
Practice Address - Country:US
Practice Address - Phone:405-733-9516
Practice Address - Fax:405-733-8853
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK1491402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100130840AMedicaid
D34962Medicare UPIN