Healthcare Provider Details

I. General information

NPI: 1255352035
Provider Name (Legal Business Name): JOHN A LOWERY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 ABERDEEN BLVD STE A
GASTONIA NC
28054-0624
US

IV. Provider business mailing address

2325 ABERDEEN BLVD STE A
GASTONIA NC
28054-0624
US

V. Phone/Fax

Practice location:
  • Phone: 704-853-3937
  • Fax: 704-853-8029
Mailing address:
  • Phone: 704-853-3937
  • Fax: 704-853-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036104884
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2012-02171
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: