Healthcare Provider Details

I. General information

NPI: 1700915287
Provider Name (Legal Business Name): KEITH G. LOWENSTEIN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15160 NW LAID LAW RD #240
PORTLAND OR
97229
US

IV. Provider business mailing address

15160 NW LAID LAW RD #240
PORTLAND OR
97229
US

V. Phone/Fax

Practice location:
  • Phone: 503-384-0044
  • Fax: 503-384-0077
Mailing address:
  • Phone: 503-384-0044
  • Fax: 503-384-0077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD17648
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberMD17648
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD17648
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMD17648
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD17648
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD17648
License Number StateOR
# 7
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD17648
License Number StateOR
# 8
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD17648
License Number StateOR
# 9
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number StateOR

VIII. Authorized Official

Name: DR. KEITH G LOWENSTEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 503-384-0044