Provider Demographics
NPI:1063953255
Name:LOWREY, BROOKS BETTISON (MD)
Entity type:Individual
Prefix:
First Name:BROOKS
Middle Name:BETTISON
Last Name:LOWREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 LEE GARLAND DR
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6877
Mailing Address - Country:US
Mailing Address - Phone:337-351-5428
Mailing Address - Fax:
Practice Address - Street 1:627 E PRUDHOMME ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6406
Practice Address - Country:US
Practice Address - Phone:337-594-3446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332752208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty