Healthcare Provider Details

I. General information

NPI: 1902098106
Provider Name (Legal Business Name): LOWELL ANTHONY CLEVELAND RCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 BROKEN SOUND PKWY NW SUITE 500
BOCA RATON FL
33487-2773
US

IV. Provider business mailing address

614 GIBBS ROAD
EVANS GA
30809
US

V. Phone/Fax

Practice location:
  • Phone: 561-367-1175
  • Fax: 561-417-7443
Mailing address:
  • Phone: 706-414-8900
  • Fax: 651-417-7443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number00015576
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: