Healthcare Provider Details

I. General information

NPI: 1073809372
Provider Name (Legal Business Name): MICHELLE L. LOWE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE L. BECKER D.O.

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9375 EMERALD COAST PKWY W
MIRAMAR BEACH FL
32550-7274
US

IV. Provider business mailing address

4205 BELFORT RD STE 4015
JACKSONVILLE FL
32216-3623
US

V. Phone/Fax

Practice location:
  • Phone: 850-278-3940
  • Fax:
Mailing address:
  • Phone: 904-450-6014
  • Fax: 904-450-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number72210
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS16298
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: