Healthcare Provider Details

I. General information

NPI: 1154383495
Provider Name (Legal Business Name): MERLIN CHANNING LOWE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 08/25/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N CAMPBELL AVENUE
TUCSON AZ
85724
US

IV. Provider business mailing address

DEPARTMENT OF PEDIATRICS 1625 N. CAMPBELL AVENUE
TUCSON AZ
85719
US

V. Phone/Fax

Practice location:
  • Phone: 520-626-6614
  • Fax: 520-626-2883
Mailing address:
  • Phone: 520-626-6614
  • Fax: 520-626-2883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35285
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35285
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: