Healthcare Provider Details

I. General information

NPI: 1205406865
Provider Name (Legal Business Name): ALEX LOWER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date: 07/28/2022
Reactivation Date: 08/30/2022

III. Provider practice location address

1901 TATE SPRINGS RD
LYNCHBURG VA
24501-1109
US

IV. Provider business mailing address

119 CORNERSTONE ST APT 1
LYNCHBURG VA
24502-5361
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-7387
  • Fax:
Mailing address:
  • Phone: 240-416-8643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110-008160
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: