Provider Demographics
NPI:1124043989
Name:LOWDER, B KERRY (MD)
Entity type:Individual
Prefix:DR
First Name:B
Middle Name:KERRY
Last Name:LOWDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:B KERRY
Other - Middle Name:
Other - Last Name:LOWDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-345-5250
Mailing Address - Fax:208-345-2364
Practice Address - Street 1:100 E IDAHO ST
Practice Address - Street 2:SUITE 400
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6223
Practice Address - Country:US
Practice Address - Phone:208-345-5250
Practice Address - Fax:208-345-2364
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5561207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology