Provider Demographics
NPI:1982669784
Name:JOHNSON, LOWELL SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:LOWELL
Middle Name:SAMUEL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9404 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-3944
Mailing Address - Country:US
Mailing Address - Phone:806-794-1747
Mailing Address - Fax:806-798-8935
Practice Address - Street 1:9404 NASHVILLE AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-3944
Practice Address - Country:US
Practice Address - Phone:806-794-1747
Practice Address - Fax:806-798-8935
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC5738207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129561006Medicaid
C17508Medicare UPIN
TX129561006Medicaid