Provider Demographics
NPI:1669413738
Name:LOWE, DOLORES KATHLEEN (MD)
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:KATHLEEN
Last Name:LOWE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DOLORES
Other - Middle Name:KATHLEEN
Other - Last Name:SPAVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10051 5TH ST N
Mailing Address - Street 2:SUITE 200 - JSA HEALTHCARE
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2289
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:727-568-6011
Practice Address - Street 1:713 SOUTH PINELLAS AVE, SUITE A-1
Practice Address - Street 2:TARPON SPRINGS PRIMARY CARE CENTER MANATEE VILLAGE SHOP
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3709
Practice Address - Country:US
Practice Address - Phone:727-935-0200
Practice Address - Fax:727-935-0201
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076211207Q00000X
FLME76211207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257359800Medicaid
FL257359800Medicaid
FL43742VMedicare PIN