Healthcare Provider Details

I. General information

NPI: 1265719975
Provider Name (Legal Business Name): DAVID M LOWRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4413 WINDING WAY DR
FORT WAYNE IN
46835-1470
US

IV. Provider business mailing address

4413 WINDING WAY DR
FORT WAYNE IN
46835-1470
US

V. Phone/Fax

Practice location:
  • Phone: 260-312-4485
  • Fax:
Mailing address:
  • Phone: 260-312-4485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17001369A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: