Provider Demographics
NPI:1891856928
Name:LOWRY, LYNNELL C (MD)
Entity Type:Individual
Prefix:
First Name:LYNNELL
Middle Name:C
Last Name:LOWRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18720 STONE OAK PARKWAY
Mailing Address - Street 2:STE 119A
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258
Mailing Address - Country:US
Mailing Address - Phone:210-697-3821
Mailing Address - Fax:210-690-0165
Practice Address - Street 1:18720 STONE OAK PARKWAY
Practice Address - Street 2:STE 119A
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-697-3821
Practice Address - Fax:210-690-0165
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK4942207W00000X
TNMD29737207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8598M0Medicare ID - Type Unspecified
G69099Medicare UPIN