Provider Demographics
NPI:1932301157
Name:LOWRY, BRENT DARREN
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:DARREN
Last Name:LOWRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 S HARVARD AVE
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2630
Mailing Address - Country:US
Mailing Address - Phone:918-749-1113
Mailing Address - Fax:918-749-1917
Practice Address - Street 1:4130 S HARVARD AVE
Practice Address - Street 2:SUITE A-1
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2630
Practice Address - Country:US
Practice Address - Phone:918-749-1113
Practice Address - Fax:918-749-1917
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK000806237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist