Healthcare Provider Details

I. General information

NPI: 1902880818
Provider Name (Legal Business Name): DAVID N LOWTHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 NELSON AVE CONTRACTING AND CREDENTIALING DEPT
MODESTO CA
95350-5341
US

IV. Provider business mailing address

2234 COLONIAL BLVD. ATTN: PAYER CONTRACTING & RELATIONS DEPT.
FORT MYERS FL
33907
US

V. Phone/Fax

Practice location:
  • Phone: 209-575-5870
  • Fax: 209-575-5872
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberA79089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: