Healthcare Provider Details

I. General information

NPI: 1730208497
Provider Name (Legal Business Name): CHAD C LOWE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E 4TH ST
LONG BEACH CA
90802-1831
US

IV. Provider business mailing address

PO BOX 30484
PORTLAND OR
97294-3484
US

V. Phone/Fax

Practice location:
  • Phone: 888-530-4415
  • Fax: 844-578-5605
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO158961
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number479
License Number StateMP
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number330554-01
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP60835057
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25IB12188300
License Number StateNJ
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A20803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: