Provider Demographics
NPI:1841345865
Name:LOWRY, PATRICK DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:DAVID
Last Name:LOWRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:320 BENEDICTINE CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-3580
Mailing Address - Country:US
Mailing Address - Phone:210-275-1252
Mailing Address - Fax:
Practice Address - Street 1:203 W LOSEY ST
Practice Address - Street 2:BLDG 1700, RM 1600
Practice Address - City:SCOTT AFB
Practice Address - State:IL
Practice Address - Zip Code:62225-5212
Practice Address - Country:US
Practice Address - Phone:618-229-5496
Practice Address - Fax:618-229-5357
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052570A171000000X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No171000000XOther Service ProvidersMilitary Health Care Provider