Healthcare Provider Details

I. General information

NPI: 1841345865
Provider Name (Legal Business Name): PATRICK DAVID LOWRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 W LOSEY ST BLDG 1700, RM 1600
SCOTT AFB IL
62225-5212
US

IV. Provider business mailing address

320 BENEDICTINE CT
O FALLON IL
62269-3580
US

V. Phone/Fax

Practice location:
  • Phone: 618-229-5496
  • Fax: 618-229-5357
Mailing address:
  • Phone: 210-275-1252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number01052570A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number01052570A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: