Provider Demographics
NPI:1982984027
Name:LOWERY, ROBBIE
Entity Type:Individual
Prefix:
First Name:ROBBIE
Middle Name:
Last Name:LOWERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 NW 145TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1745
Mailing Address - Country:US
Mailing Address - Phone:580-660-1728
Mailing Address - Fax:
Practice Address - Street 1:1812 NW 145TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1745
Practice Address - Country:US
Practice Address - Phone:580-660-1728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-21
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)