Provider Demographics
NPI:1801071550
Name:LOWE, RANDY EDWARD (DPM)
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:EDWARD
Last Name:LOWE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 E RIVERPARK LANE
Mailing Address - Street 2:STE 110
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706
Mailing Address - Country:US
Mailing Address - Phone:208-387-0900
Mailing Address - Fax:208-345-5883
Practice Address - Street 1:671 E RIVERPARK LANE
Practice Address - Street 2:STE 110
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-387-0900
Practice Address - Fax:208-345-5883
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP1423213EP1101X
IDP-142213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002725800Medicaid
ID5308810001Medicare NSC
ID1350738Medicare PIN