Provider Demographics
NPI:1013972306
Name:STANFORD, LOWRY C JR (MD)
Entity type:Individual
Prefix:
First Name:LOWRY
Middle Name:C
Last Name:STANFORD
Suffix:JR
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 1:39 FRANKLIN RD
Mailing Address - Street 2:STE 220
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1588
Mailing Address - Country:US
Mailing Address - Phone:601-296-3050
Mailing Address - Fax:
Practice Address - Street 1:39 FRANKLIN RD
Practice Address - Street 2:STE 220
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1588
Practice Address - Country:US
Practice Address - Phone:601-296-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17927208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09016137Medicaid
MS08539218Medicaid
MS512I370031Medicare PIN
MS08539218Medicaid