Provider Demographics
NPI:1124080866
Name:LOWREY, JAMES RUSSELL (DPM)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RUSSELL
Last Name:LOWREY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:RUSSELL
Other - Last Name:LOWREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:8583 W LINEBAUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-3731
Mailing Address - Country:US
Mailing Address - Phone:813-855-3606
Mailing Address - Fax:813-926-0632
Practice Address - Street 1:8583 W LINEBAUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-3731
Practice Address - Country:US
Practice Address - Phone:813-855-3606
Practice Address - Fax:813-926-0632
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2798213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340189800Medicaid
65615OtherBLUE CROSS BLUE SHIELD
030514682OtherTAX ID
FL219678OtherAMERIGROUP
U75250Medicare UPIN
4781060001Medicare NSC
P00017664Medicare ID - Type UnspecifiedMEDICARE RAILROAD
030514682OtherTAX ID