Healthcare Provider Details

I. General information

NPI: 1700850518
Provider Name (Legal Business Name): RICHARD GREGORY LOWE PH.D., AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3124 E STATE BLVD SUITE 1A
FORT WAYNE IN
46805-4763
US

IV. Provider business mailing address

3124 E STATE BLVD SUITE 1A
FORT WAYNE IN
46805-4763
US

V. Phone/Fax

Practice location:
  • Phone: 260-471-5693
  • Fax: 260-471-4942
Mailing address:
  • Phone: 260-471-5693
  • Fax: 260-471-4942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23001004
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: