Provider Demographics
NPI:1861444903
Name:NOWLIN, LINCOLN RANDALL (DPM)
Entity Type:Individual
Prefix:DR
First Name:LINCOLN
Middle Name:RANDALL
Last Name:NOWLIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 E YOUNG AVE
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-1228
Mailing Address - Country:US
Mailing Address - Phone:660-429-2626
Mailing Address - Fax:660-429-3356
Practice Address - Street 1:521 E YOUNG AVE
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-1228
Practice Address - Country:US
Practice Address - Phone:660-429-2626
Practice Address - Fax:660-429-3356
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000757213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000B609Medicare ID - Type Unspecified
MOU65492Medicare UPIN
MO4332810001Medicare NSC