Provider Demographics
NPI:1013912997
Name:LOWREY, JONATHAN S (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:S
Last Name:LOWREY
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 1:2511 WEST 900 SOUTH
Mailing Address - Street 2:
Mailing Address - City:HUNTINGBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47542-9628
Mailing Address - Country:US
Mailing Address - Phone:812-683-1500
Mailing Address - Fax:812-683-1600
Practice Address - Street 1:2511 WEST 900 SOUTH
Practice Address - Street 2:
Practice Address - City:HUNTINGBURG
Practice Address - State:IN
Practice Address - Zip Code:47542-9628
Practice Address - Country:US
Practice Address - Phone:812-683-1500
Practice Address - Fax:812-683-1600
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26869207L00000X
IN01039645A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200003110Medicaid
INP00358546OtherRR MEDICARE
IN000000501005OtherBCBS - DEACONESS GATEWAY
194556OtherHEALTHLINK # - DEACONESS
KY64879224Medicaid
IL2###0####Medicaid
IN000000185797OtherBCBS - DEACONESS MARY ST
5922739OtherAETNA # - DEACONESS
1065073OtherFIRST HEALTH# - DEACONESS
1065073OtherFIRST HEALTH# - DEACONESS
KY64879224Medicaid
INP00358546OtherRR MEDICARE