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General NPI Number Information
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NPI Number | 1295916591
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Entity Type | Organization
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Legal Business Name | R. GREGORY LOWE, PH.D., P.C.
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 3124 E STATE BLVD SUITE 1A
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City | FORT WAYNE
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State | IN
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Zip | 46805-4798
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Country | US
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Telephone | 260-471-5693
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Fax | 260-471-4942
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Provider Business Mailing Address
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Address Line | 3124 E STATE BLVD SUITE 1A
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City | FORT WAYNE
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State | IN
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Zip | 46805-4798
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Country | US
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Telephone | 260-471-5693
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Fax | 260-471-4942
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. R GREGORY LOWE
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Credential | PH.D., AU.D.
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Telephone | 260-471-5693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 23001004
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License Number State | IN
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